While the health sector awaits Bolsonaro’s decision on the bill on the ANS (National Supplementary Health Agency) list, Paulo Rebello, president of the agency, says he expects him to veto a specific section of the coverage conditions outside the list, which releases treatments that have proven efficacy based on scientific evidence.
The text was too open, according to Rebello, and it will be necessary to move forward with regulation.
He sees “political logic” in the position of the Minister of Health, Marcelo Queiroga, who stopped supporting the veto.
Another matter of concern, according to Rebello, is the nursing floor, which can boost prices for the user and compromise the balance of the system.
Your expectation in the case of the tax role is that President Bolsonaro will sanction or not?I want to believe that he will veto the first item of paragraph 13 of the 2033 bill, which addresses the issue of evidence-based medicine. It was a very open text. You establish what is in the literature, that is, you have levels of evidence.
Was the debate on this topic and on the nursing floor affected by the electoral period?We are in a moment coming out of the pandemic, but still with an excessive number of deaths by Covid, and the electoral period is ahead. It ended up generating the mobilization of some people and pressured the Legislature to make these changes.
We have been discussing in a logic of a very open text. Evidence-based medicine has levels of evidence. You can have an expert opinion, a case study, or those more comprehensive systematic review cases.
It needs to be regulated, if not vetoed.
Conitec [Comissão Nacional de Incorporação de Tecnologias no SUS], which we resemble, has criteria. As the text was open, we also want to present a proposal, either via decree, and I haven’t talked to anyone yet, but it came to my mind, or via the ANS regulation itself.
And would you have support from the Minister of Health? The ANS has asked for this veto, but Mr. Haven’t I already said that I would also like the minister to do that?He did this, when he was at the public hearing in the Senate, where he expressed himself in favor of the agency’s position, and at another time when his executive secretary was in a meeting with the senator [Eduardo Girão] Girão, in which he also expressed himself in favor of the position of the ANS.
Obviously, I expected his stance to remain that way. So, when he says he won’t speak up, there’s a political logic there, which I think he made a balance between defending what is technically acceptable or politically acceptable.
But we have to defend our position and that’s what we did, in our technical note, to veto the total project or veto the first item.
Is there any concern of the ANS about emptying the agency’s role in the case of releasing the list?In fact, the agency is competent to carry out this study of technology assessment in health, of incorporation. This project specifically doesn’t have that. He does not frighten us.
The text is actually a copy and paste of the text that is already applied, which is already in the law today. And the only change is that it allows beneficiaries to look for operators to incorporate that particular technology. If they don’t, they will go to court.
In fact, they thought that, as a result of that STJ decision, they would lose the right to be able to judicialize [em junho, o Superior Tribunal de Justiça, desobrigou os planos de cobrir procedimentos fora da lista]. That wouldn’t happen.
But of our work, nothing changes. We will continue to carry out health technology assessments and incorporate, as we have already incorporated 30 new technologies this year, and operators will follow.
like mr. have you seen the debate on the nursing floor? The companies in the sector went to the ANS to warn that it will cause a rise in the price of health plans. How big is the concern?The individual adjustment formula captures this variation in assistance expenses, that is, every incorporation and every new cost embedded in the sector will be passed on to the beneficiary. So it actually causes the increase.
When I say that I am in favor, that the decision was correct, it is because there are certain premises. It is to establish what this fund would be to offset these costs.
The impact of this within the supplementary health sector is one. But in the Sistema Único it has a gigantic impact, in the Santas Casas as well. There are 825 municipalities that only have a single hospital. From the moment this cost is passed on to the municipality and the states, they will not be able to bear these expenses. As a result, it will close.
It becomes a public health problem. I got a call from Pernambuco from a home care company that laid off 800 people. There is a concern, which is the logic of sustainability, of financing the sector, whether public or private.
That’s my concern, analyzing technically. Not to mention the pass-through it can have to consumers.
It’s a legitimate claim. I don’t question it, but there is a concern with the balance of the sector. This is my expression of support for the decision of the STF, which was considered.
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He studied law at Unipê (University Center of João Pessoa). He was head of the minister’s office at the Ministry of Health from 2016 to 2018. At ANS (National Supplementary Health Agency), he was elected to serve as director-president until 2024. Before, he was director of Standards and Qualification of Operators at the agency .
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