title: The elderly and healthcare plans in Brazil: analysis of the complaints received by the National Regulatory Agency for Private Health Insurance and Plans.
abstract: Although the Unified Healthcare System provides universal coverage, about 25% of the population in Brazil has some form of private healthcare. Considering that the population is aging, the prevalence of chronic diseases and the high costs associated with healthcare, the goal of this study is to assess if the barriers to access and use of the services offered by healthcare plans, expressed as beneficiary complaints, have a greater impact on the elderly than on adults and children. Transverse, exploratory study using a quantitative descriptive approach and secondary data provided by the ANS (the National Regulatory Agency for Private Health Insurance and Plans). This study analyzed complaints filed with the ANS by beneficiaries in the Southeast of Brazil between 2010 and 2012. The study population corresponded to 92,235 complaints. The elderly filed proportionately more complaints (60.8 vs. 25.5 complaints per 10 thousand beneficiaries). The most frequent (68.1%) complaints by the elderly were related to coverage. The results reinforce the idea that the organizational elements of private healthcare plans affect especially those groups most likely to use healthcare plans.
authors.affiliation: Núcleo da ANS Rio de Janeiro, Agência Nacional de Saúde Suplementar, Rio de Janeiro, RJ, Brasil, wilsonmvjr@yahoo.com.
authors.forename: Wilson Marques
authors.initials: WM
authors.lastname: Vieira Junior
authors.affiliation: Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz.
authors.forename: Mônica
authors.initials: M
authors.lastname: Martins
mesh_terms: D000368:Aged; D000375:Aging; D001938:Brazil; D005260:Female; D006298:Health Services Administration; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health; D008297:Male; D017149:Private Sector; D018855:Single-Payer System