What’s the rol of Supplementary Health Care System proceedments and events?
The rol of proceedments and events in health is the list of proceedments, that includes appointments, exams and treatments that should, by law, be offered by the Supplementary Health Care System as a minimal and required coverage by the health insurance operators.
When was it institutionalized?
The first list was stablished by the regulatory agency of the health plan operators in Brazil – ANS (Agência Nacional de Saúde Suplementar) and defined by the Resolução de Conselho de Saúde Suplementar in 1998.
The first was published in 2000 by the Resolução de Diretoria Colegiada number 41, (RDC 41). After that it was updated in 2001 (RDC 67), and one more time around 2004 by (RN 82), 2008 (RN 167), 2010 (RN 2011), 2011 (RN 262), 2013 (RN 238), 2015 (RN 387) normative resolutions. Lastly, in 2017 we had a publishment in the Diário Oficial da União the RN becomes effective in January 2nd 2018.
Who defines which proceedments are included?
The frequent updates of the Rol of Proceedments and Events in Health are prupose by a technical group formed by the goverment representatives and the ANS, health profissionals, health insurance operators and consumer defense entities that get together in the scope of the Comitê Permanente de Regulação da Atenção à Saúde. (COSAUDE).
After deciding what things need to be changed, the project is presented to a society assessment through an online public consultation. So, the proposal is to put forward to the Diretoria Colegiada of ANS to its approval and publishment. The COSAUDE meetings were, in this last rol, accomplished between November 2016 and March 2017.
Which criterions are used for inclusion?
According to the ANS, “the inclusion of technologies is always preceded by a judicious assessment, lined up with the national health politics, and besides the scientific evidences, it contemplates the social need and the availability of resources”.
Indeed, “The decision taken to include proceedments in the rol thinks about the epidemiology of the disease, the effectiveness and the safety of the technology, always based on the best scientific evidence ( Evidence-Based Medicine – EBM) so it can be safe to people, but not forgetting about the costs involved and what they represent to the sustainability of the sector”.
The technical word to these assessments is Health Technology Assessment (Avaliação de Tecnologia em Saúde, ATS), and it’s included cost-effectiveness and budget impact assessments over the perspective of the Supplementary Health Care System.
Besides that, the agency evaluetes a serie of other criteria, including: “The existance of a network provider, the facility to use, handling, getting and making the technology available, insumes and feedstock are revelevant aspects considering the proceedering incorporation”, this is particulary relevant to the medical devices, the called (in Portuguese) OPME (bracing, prosthesis and special supplies) which are the input used in each intervention in health.
The process of inclusion of technologies in the Brazilian health
The improvement of life conditions in our society with a clear demographic condition (we are from a country with each time fewer young people and more elderly people) and epidemiological (with chronic diseases), adding the health systems sophistication, causes the increase of the costs to the health system, because of it the incorporation of technology proceedments in health is a challenge to its managements.
Besides the constitutional principal that health is everybody’s right and it’s ought to the country to give heath to people, the access to health is conditional on the existence of a budget , that’s why the inclusion of proceedments demands a cost-effectiveness assessment, and with a budgetary impact, based in technical-scientific criteria to analyze what’s the price and the impact in the managment’s budge and what this incorporation would bring about on the next years, comparing to other technologies that have already been used by the Supplementary Health.
The difficulties to incorporate new technologies
In a context of scarce resources and decentralized decision-making processes, the ideal would be to create an universal health system and integrated in its public and private face, with full attention and equanimity.
While this doesn’t happen, a big challenge to face would be the behavior changes as the indication of members to the commission according to their competences so the decisions will be based on technical criteria, not on political criteria; Extending process transparency; Training the human resources; Assessment of the different kinds of economical assessment studies (cost-effectiveness, cost-utility, cost-minimization) and promoting partnerships with public and private entities and teaching hospitals to accomplish technology assessment studies.
Although, the politic aspect will always be there because the various actors of the health system will have to debate what has real value and what should be used in the health systems.
The process of incorporating technologies in health in Brazil is normalized for a few years, comparing to other countries, and besides the high level of scientific evidence of the performed studies to make decisions, there’s still a lot to improve to accomplish excellence in this process.
How to get in this market
As we have seen, incorporating a new technology related to health in the Supplementary Health Care System of Brazil is a complex and interactive process with many actors of the systems, what demands specialized professionals in health technology assessment, economic assessments and with a high capacity of developing institutional relationships to gain a big access to the health systems.
In the next article we will understand better all the proceedments we need to launch a product in this scenario.