A study by the Regulation in Numbers Project at Fundação Getulio Vargas’ Rio de Janeiro Law School shows that the list of mandatory minimum coverage maintained by the National Health Insurance Regulatory Agency (ANS) has been updated more frequently in recent years. The participation of civil society has also increased. Medical professionals, patients and people related to patients (relatives, friends and caregivers) have been the most active groups in public consultations.

The study was carried out by two researchers at FGV’s Rio de Janeiro Law School: José Luiz Nunes, of the school’s Center for Technology and Society (CTS); and Lucas Thevenard Gomes, of the Regulation in Numbers Project. The study was based on figures compiled by the project.

The study also shows that the number of contributions regarding additions, deletions or alterations to the list of mandatory minimum coverage increased nearly six-fold in 2020, to more than 30,000. Most of these contributions were related to surgeries (50%) and medications (47%). Extraordinary updates, involving medical services related to COVID-19, accounted for fewer than 1% of the contributions.

Decision by Superior Court of Appeals

A recent decision by the Superior Court of Appeals established that health insurers are not obliged to pay for medical services that are not included on ANS’ list of mandatory minimum coverage. “The Superior Court of Appeals’ decision makes it particularly important to understand how ANS decides what procedures are added to the list,” says researcher José Luiz Nunes, one of the study’s authors.

The agency periodically updates the list. ANS Resolution 465 of 2021 increased the frequency from every two years to every six months. ANS may also make extraordinary alterations to the list between regular updates.

In recent years, the regulator has made extraordinary changes to the list more often. This phenomenon is not simply due to the inclusion of procedures related to combating the novel coronavirus pandemic, as most of the items recently included are not linked to the disease.

Another aspect analyzed in the study was social participation in the periodic update process, especially through public hearings. The study indicated that most of these contributions came from individual members of civil society and there was a large increase in 2020. The main groups involved were health professionals, patients and people related to patients (relatives, friends and caregivers). This indicates great interest among individuals who have a direct relationship with the sector in contributing to ANS’ rule-making process, which is a more important means to guarantee access to treatments following the Superior Court of Appeals’ decision.

According to researcher Lucas Thevenard, the data shows that ANS has become more active in managing the list of mandatory minimum coverage and society is more involved in the process. “Activism and engagement with the public are necessary conditions, if we want the list to be compatible with the population’s health demands,” says the researcher, who also worked on the study.