Liquidação de operadoras de planos de assistência à saúde no Brasil

Abstract

The supplemental health insurance market has experienced substantial growth in Brazil in recent years, especially over the last decade. Data from the Brazilian Supplemental Health Care Agency (ANS acronym in Portuguese) show the supplemental health care system included 47.9 million customers as of December 2016. Despite annual growths in the number of health insurance customers, the number of Health Insurance Providers has been falling since the creation of ANS. In fulfilling its regulatory role, ANS has the objective of guaranteeing the public interest in the relations between consumers and health insurance providers. When serious operational or economic and financial abnormalities are detected in any provider, ANS shall enforce special rules for technical or fiscal management, thus acting more effectively in the providers management. The objective of this masters thesis was to analyze the influence of ANS regulation on the providers continuity. A logistic regression with panel data was performed using 26 economic and financial variables deflated one and two years before the providers insolvency. These variables encompassed indicators calculated building on the providers economic and financial data. In addition, dummy variables accounted for the providers characteristics as to modality, size, region and segmentation. The main variable of the study measures ANSs influence on the providers continuity. A dummy was used for this variable to account for the providers inclusion or not in a special management regimen before insolvency. Insolvency was admitted to providers that had their registration canceled by ANS and have negative or zero equity. The sample consisted of 9,656 cases distributed from 2007 through 2015. A sample of 478 cases was used in isolation for validating the model of insolvency, thus totaling 10,134 cases. The results showed the variable that measures the ANS influence on the providers continuity was significantly important as a predictor of insolvency, and the model generally predicted 86.37% of the cases correctly. Other variables proved to be significant as predictors of insolvency, namely: indebtedness, HIP performance, asset turnover, immobilization, and immediate liquidity for one-year deflation; and indebtedness and net profit margin for twoyears deflation. Significant dummy variables related to the providers characteristics included administrator, medical cooperative, philanthropy, group dentistry, and secondary subsidiary segment. The providers region, size and most of their segmentation variables were not relevant as predictors of insolvency. This thesis contributes to both the academic field and the market by adding to economic and financial indicators and providers characteristics a new dummy variable related to ANS regulation through special rules for management. Further studies are welcome to use the regression technique for survival data such as Cox Proportional Risks and to adopt classification criteria for insolvent companies based on the providers solvency margin index as calculated using ANS Normative Ruling No. 209.