Nos últimos 50 anos, os planos de saúde saíram praticamente do zero para formar, em 2017, um mercado que reúne nada menos do que 47 milhões de clientes. Uma fatia de 38% disso está nas mãos do sistema Unimed, que começou como uma pequena cooperativa de médicos em Santos, no litoral paulista. O grupo de duas dezenas de médicos virou um emaranhado complexo que hoje compreende quase 350 cooperativas, com 114.000 "sócios" - para se credenciar os médicos compram cotas, que podem custar de 2.000 a mais de 50.000 reais.
Segundo o presidente da Unimed do Brasil, Orestes Pullin, a concorrência nos grandes centros é grande, mas no interior há espaço. As empresas de saúde suplementar ainda vão pouco para as cidades pequenas.
O sistema conta com 113 hospitais próprios e 2.719 credenciados. A capilaridade garante acesso a novos clientes, mas dificulta a gestão. Em conjunto, a rede Unimed faturou 64 bilhões de reais em 2016.
(Fonte: revista Melhores & Maiores de Exame - 2017)
English version:
In 2015, when Unimed Paulistana collapsed, the National Supplementary Healthcare Agency (ANS) forced three healthcare cooperatives of the Unimed system to assume the portfolio of individual health plans of the São Paulo unit. In 2016, the system’s members were also called by the ANS to monitor closely the crisis of Unimed-Rio — one of its largest operations in the country. The two cases seem to have served as a warning that something needed to change in the fully decentralized model that Unimed adopted until then. Measures in the direction of a more integrated system were taken and are being strengthened in 2017.
“We have to have a closer monitoring. The occurrences will not be responsibility of the ANS. We need to have centralization of some things,” says Orestes Pullin, who in April 2017 took the presidency of Unimed do Brasil, entity that manages and represents the cooperatives that operate under the brand.
Late 2016, the members approved changes in the system’s bylaws. Now, Unimed do Brasil may demand from the cooperatives information of any type and make on-site inspections of the structures. The federations (which represent the cooperatives of a certain region or state) are also free now to convene meetings with boards and members to discuss their financial situation, in addition to conducting audits.
Now, a centralized database with information of patients, the Electronic Health Register (RES), is in test phase. Unimed do Brasil is also internally developing a business intelligence system to aid in its decision-making. “It is a new challenge of the evolution of the system. A new leap to be taken,” says Helton Freitas, of Seguros Unimed. He is also a member of the new management of Unimed do Brasil, which took office for a four-year term, together with Alexandre Ruschi (of Central Nacional Unimed) and Nilson Luiz May (of Unimed Participações).
The Unimed system is comprised of 348 cooperatives (293 operators that sell healthcare plans to customers and the rest entities such as federations) that gather 114,000 doctors, serve 18 million people and account for 29% of the Brazilian health-insurance market. In 2016 through September, latest information available, the system had R$48 billion in revenues and a R$1.3 billion profit.
Mr. Pullin says there is less resistance today from cooperatives to share information about their operations, since these data need to be made public by an ANS demand.
A closer look over the cooperatives’ performance began being adopted in 2013. Today, eight cooperatives work on what was called “preventive internal plans,” to adjust their operations. The names are not disclosed for matters of confidentiality.
Unimed do Brasil, which has no intervention power in the cooperatives, monitors the execution of the plan offering information about prices that may need to be adjusted to balance accounts, or negotiations between cooperatives for the payment of debts — as it happened with Unimed-Rio, which gained a longer term to settle a R$100 million debt to other cooperatives for serving patients outside of their state of origin, the so-called exchange.
The Unimed executives advocate — not only for their system, but for the entire health-insurance market — the broadening of the concept of primary care, of having a primary physician who refers clients to specialists instead of having customers choosing a doctor for the specialty directly. Mr. Ruschi says this is a much more efficient and less costly model.
At Unimed-Vitória, of which he was president, Mr. Ruschi says users of this model represent a cost 43% lower than those of the general clientele and take half of the number of exams. “It is even a cheaper plan for the client [because it has a lower cost],” he says. Unimed units started studying the primary-care model in 2011, and today it is implemented by 30, with 150,000 participant patients.
Mr. Freitas acknowledges it is not easy to adopt such model, because of factors including lack of physicians prepared for this type of service and of the structure of the healthcare system. But he points out that the debate on the subject needs to be done, since the model that remunerates for the quantity of appointments and exams made is unsustainable in the medium and long runs.
(Fonte: jornal Valor international edition - April 2017)
Segundo o presidente da Unimed do Brasil, Orestes Pullin, a concorrência nos grandes centros é grande, mas no interior há espaço. As empresas de saúde suplementar ainda vão pouco para as cidades pequenas.
O sistema conta com 113 hospitais próprios e 2.719 credenciados. A capilaridade garante acesso a novos clientes, mas dificulta a gestão. Em conjunto, a rede Unimed faturou 64 bilhões de reais em 2016.
(Fonte: revista Melhores & Maiores de Exame - 2017)
English version:
In 2015, when Unimed Paulistana collapsed, the National Supplementary Healthcare Agency (ANS) forced three healthcare cooperatives of the Unimed system to assume the portfolio of individual health plans of the São Paulo unit. In 2016, the system’s members were also called by the ANS to monitor closely the crisis of Unimed-Rio — one of its largest operations in the country. The two cases seem to have served as a warning that something needed to change in the fully decentralized model that Unimed adopted until then. Measures in the direction of a more integrated system were taken and are being strengthened in 2017.
“We have to have a closer monitoring. The occurrences will not be responsibility of the ANS. We need to have centralization of some things,” says Orestes Pullin, who in April 2017 took the presidency of Unimed do Brasil, entity that manages and represents the cooperatives that operate under the brand.
Late 2016, the members approved changes in the system’s bylaws. Now, Unimed do Brasil may demand from the cooperatives information of any type and make on-site inspections of the structures. The federations (which represent the cooperatives of a certain region or state) are also free now to convene meetings with boards and members to discuss their financial situation, in addition to conducting audits.
Now, a centralized database with information of patients, the Electronic Health Register (RES), is in test phase. Unimed do Brasil is also internally developing a business intelligence system to aid in its decision-making. “It is a new challenge of the evolution of the system. A new leap to be taken,” says Helton Freitas, of Seguros Unimed. He is also a member of the new management of Unimed do Brasil, which took office for a four-year term, together with Alexandre Ruschi (of Central Nacional Unimed) and Nilson Luiz May (of Unimed Participações).
The Unimed system is comprised of 348 cooperatives (293 operators that sell healthcare plans to customers and the rest entities such as federations) that gather 114,000 doctors, serve 18 million people and account for 29% of the Brazilian health-insurance market. In 2016 through September, latest information available, the system had R$48 billion in revenues and a R$1.3 billion profit.
Mr. Pullin says there is less resistance today from cooperatives to share information about their operations, since these data need to be made public by an ANS demand.
A closer look over the cooperatives’ performance began being adopted in 2013. Today, eight cooperatives work on what was called “preventive internal plans,” to adjust their operations. The names are not disclosed for matters of confidentiality.
Unimed do Brasil, which has no intervention power in the cooperatives, monitors the execution of the plan offering information about prices that may need to be adjusted to balance accounts, or negotiations between cooperatives for the payment of debts — as it happened with Unimed-Rio, which gained a longer term to settle a R$100 million debt to other cooperatives for serving patients outside of their state of origin, the so-called exchange.
The Unimed executives advocate — not only for their system, but for the entire health-insurance market — the broadening of the concept of primary care, of having a primary physician who refers clients to specialists instead of having customers choosing a doctor for the specialty directly. Mr. Ruschi says this is a much more efficient and less costly model.
At Unimed-Vitória, of which he was president, Mr. Ruschi says users of this model represent a cost 43% lower than those of the general clientele and take half of the number of exams. “It is even a cheaper plan for the client [because it has a lower cost],” he says. Unimed units started studying the primary-care model in 2011, and today it is implemented by 30, with 150,000 participant patients.
Mr. Freitas acknowledges it is not easy to adopt such model, because of factors including lack of physicians prepared for this type of service and of the structure of the healthcare system. But he points out that the debate on the subject needs to be done, since the model that remunerates for the quantity of appointments and exams made is unsustainable in the medium and long runs.
(Fonte: jornal Valor international edition - April 2017)
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