Práticas Sustentáveis em Planos de Saúde

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Práticas Sustentáveis em Planos de Saude

Introdução

O Instituto de Estudos de Saúde Suplementar (IESS) apresenta um manual simples para a fácil compreensão do público com o
objetivo de trazer esclarecimentos sobre como manter práticas sustentáveis na utilização dos planos de saúde. Antes de tratar do assunto propriamente dito será apresentado o porquê da necessidade de ter práticas sustentáveis na utilização de planos de saúde, o que isso gera de benefícios aos beneficiários e ao sistema de saúde suplementar.

Qual a importância das práticas sustentáveis?

O princípio básico de um plano ou seguro de saúde é o mutualismo. Ele se baseia na solidariedade financeira entre segurados de um mesmo grupo homogêneo em relação ao perfil de risco: todos contribuem com uma mensalidade fixa para que o dinheiro possa custear os tratamentos daqueles poucos que tiverem a infelicidade de adoecerem. O perfil de risco, ou o custo médio dos tratamentos, cresce com a idade. Por isso, as pessoas são agrupadas por faixas etárias, de modo que os beneficiários que estão na mesma faixa etária apresentam riscos semelhantes em relação à sua saúde e por isso pagam uma mensalidade igual.

Além dessa solidariedade entre as pessoas da mesma faixa etária, existe também, uma solidariedade intergeracional, como resultado implícito da forma como são definidos os preços para cada faixa etária. Na prática, os beneficiários mais jovens (de menor risco) pagam uma mensalidade um pouco maior do que seu custo do risco para que os mais idosos tenham uma mensalidade menor do que o custo médio dessa faixa etária.

1ª faixa etária DE 0 A 18 ANOS

última faixa etária 59 ANOS OU MAIS

Portanto, é importante entender que as ações que um beneficiário faz isoladamente afetam tanto o próprio individuo como também os demais que compartilham do plano ou seguro de saúde.

O uso consciente do plano de saúde beneficia em primeiro lugar a saúde de quem o pratica. Além disso evita desperdício, exigindo assim reajustes menores nas mensalidades.

O aumento da mensalidade decorre dos aumentos das despesas e essas vêm dos aumentos da frequência de utilização, do preço médio dos procedimentos, materiais e medicamentos e das incorporações de tecnologia. O envelhecimento também impacta as despesas com saúde1 porque com a idade tendemos a ter gastos maiores com saúde.

Reduzir Desperdícios de mal uso

ta cartilha iremos apresentar ações tipificadas como fraudes ou desperdícios que devem ser evitadas pelos beneficiários, seguindo práticas sustentáveis na utilização do plano de saúde e assim reduzindo o ritmo de crescimento das despesas, promovendo a sustentabilidade do sistema de saúde suplementar.

Um exemplo prático para maior compreensão antes de iniciarmos a Cartilha é pensarmos em um lar composto por quatro pessoas. Se todos os membros da família utilizarem a energia elétrica de forma consciente, a conta será rateada entre os quatro membros e todos irão participar de forma justa no pagamento dos custos realizados.

No entanto, se um indivíduo utiliza a energia de modo que cause muito desperdício e não atua com zelo, no final do mês, o valor da conta será mais alta. O valor adicional em relação à conta normal será rateado entre os quatro, mas três deles irão arcar com uma despesa maior do que a por eles gastada. A pessoa que fez uso com desperdício arcará com quarto do valor adicional, deixando para os outros três os outros três quartos.

Com o plano de saúde é a mesma coisa: qualquer ação de um indivíduo impacta nos demais tanto de forma positiva ou negativa. E consequentemente, a má utilização encarece a mensalidade para todos. Este que é em prática o princípio básico do seguro que é o mutualismo, como foi descrito anteriormente.

Práticas sustentáveis que podem ajudar a conter o aumento das mensalidades


1- Declaração de Plano de Saúde

O beneficiário deve preencher corretamente a Declaração do Plano de Saúde, não omitindo informações nem falseando.

Segundo a Agência Nacional de Saúde Suplementar (ANS), a declaração de saúde tem por objetivo solicitar ao beneficiário informações a respeito de seu estado de saúde e de possíveis doenças ou lesões preexistentes (DLP). Doença ou lesão preexistente é aquela saiba ser portador no momento da contratação ao plano de saúde. A operadora não pode negar a aceitação, mas a ela é facultado oferecer Cobertura Parcial Temporária (CPT)2 ou um agravo.

A ANS informa que não podem constar neste formulário perguntas sobre hábitos de vida, fatores de risco, sintomas e tampouco sobre o uso de medicamentos. Este formulário é o que acompanha o Contrato de Plano de Saúde.

A operadora, caso o beneficiário aponte alguma doença preexistente não poderá negar a cobertura assistencial de saúde, mas poderá oferecer cobertura total ou cobertura parcial temporária (CPT), podendo ainda oferecer agravo, que é um acréscimo no valor da mensalidade para o plano de saúde.

Omitir informações no formulário é uma fraude e a operadora poderá abrir processo  administrativo  junto à ANS para rescindir o contrato e responsabilizar o contratante pelos procedimentos referentes a doença ou lesão não declarada.

2-Carteira de Identificação do beneficiário


Você é o único que pode utilizar sua
carteirinha nos serviços de saúde contratados. O cartão de identificação é nominal e intransferível. A utilização por terceiros é fraude. O uso irregular é uma despesa sem a correspondente contribuição, já que a utilização se deu por quem não era beneficiário. Esse custo adicional recairá sobre todos os beneficiários do plano.

2-Reembolso

O reembolso é a possibilidade de um beneficiário utilizar procedimentos e serviços de saúde que estão fora da rede conveniada ou referenciada, podendo solicitar o reembolso da despesa. Notar que o reembolso está sempre limitado ao que estiver estipulado em contrato.

a.  Duas notas fiscais por uma única consulta


O beneficiário, ao realizar algum procedimento ou consulta com especialista no particular, deve apresentar a nota fiscal com o
valor integral do serviço. Pedir ou aceitar o desdobramento em dois recibos com datas

diferentes com o objetivo de receber um reembolso mais alto pela consulta ou procedimento, é uma prática irregular e fraudulenta. São fraudadores aqueles recebem notas fiscais desdobradas assim como aqueles que as emitem

Esse ato é fraude e pode ser rastreado pela receita federal e pelas operadoras. Além disso, o praticante dessa irregularidade descarrega o custo sobre os ombros de todos os outros participantes do plano.

 b. Alterar para maior o valorda nota fiscal para o  reembolso

Solicite sempre o valor correspondente ao serviço de saúde prestado no caso de reembolso. O reembolso de consultas e procedimentos está vinculado a um teto a ser ressarcido ao beneficiário, conforme estabelecido em contrato. Qualquer que seja o objetivo, é fraude o paciente aceitar a oferta de uma nota fiscal de valor superior ao valor pago a quem realiza

o serviço de saúde. Também pratica uma fraude aquele que aceita emitir nota fiscal com valor maior do que o recebido. Tanto esse ato, como o anterior, são ilícitos que aumentam as despesas com saúde e portanto as mensalidades nos planos.

c. A senha de acesso do site do beneficiário é de domínio particular

Não deve o beneficiário compartilhar a sua senha do portal do beneficiário para terceiros realizarem o reembolso. Alguns consultórios e laboratórios de exames estão adotando a prática de solicitar o reembolso para o beneficiário através do portal, no entanto, isto não é aconselhável, pois pode haver solicitações de reembolso para procedimentos não efetuados.

4-Famílias criam empresas para ter plano empresarial

O indivíduo que não possui plano de saúde pela empresa pode realizar a adesão por meio de planos de saúde individuais ou coletivos por adesão. A criação de pequenas empresas com o intuito de aderir a planos coletivos empresariais deve observar os critérios estabelecidos pela RN 432/2017 da ANS, entre eles a empresa precisa estar estabelecida há pelo menos 6 meses.

A criação de empresas fictícias, com o único propósito de contratar plano coletivo é crime tipificado em lei. Assim como é crime inserir em empresa existente em situação regular nome de pessoa com o único objetivo de ser incluída no plano empresarial de saúde.

5-Utilização de Urgência e Emergência x Consultório

 

Ir ao pronto socorro (PS) em caso de emergência. A ida ao pronto-socorro deve ser realizada quando necessário, de forma adequada, para não implicar em uso desnecessário dessa facilidade.

O beneficiário deve sempre que possível utilizar a consulta médica fora do ambiente hospitalar quando esta não for uma urgência ou emergência. Geralmente, o custo de atendimentos como consultas e exames no PS é superior ao custo de atendimentos praticados em consultório e laboratórios. Na maioria de vezes, representa desperdício.

O ideal é que o beneficiário realize consultas de rotina com seu médico de confiança e evitar ida ao pronto socorro de forma inadequada.

Como alternativa, ele pode recorrer ao uso da Telemedicina. A não utilização de forma correta desse recurso gera desperdícios que terminarão por impactar a mensalidade dos planos de saúde.

6-Cuidados com a Prevenção

Cuidar da própria saúde ajuda não apenas o indivíduo, mas também o sistema de saúde suplementar a ter sustentabilidade.

Nossa saúde depende de nós mesmos. Estatísticas informa que metade de nosso estado de saúde depende do que fazemos, do que comemos, do ambiente em que vivemos, da qualidade do ar que respiramos, dos tóxicos que ingerimos com os alimentos, se guardamos rancor e ódio ou se amamos e perdoamos. Algumas dessas coisas estão fora de nossa gestão. Outras, pelo contrário, são escolhas que fazemos no dia a dia, até mesmo de forma automática, comandadas pelos nossos hábitos. Depende de cada um de nós adotarmos hábitos saudáveis, que preservam nossa saúde, evita que adoeçamos, nos dão vida longa com saúde. Descruze os braços, informe-se e adote esses hábitos que sua saúde será forte e com isso gastaremos menos com saúde. O sistema suplementar e o público também se tornam mais sustentáveis.

Você deve também seguir as recomendações das sociedades de especialidades médicas quanto à realização de exames preventivos (mama, próstata, intestinos etc.).

Saiba, no entanto, que você só deve fazer os exames periodicamente conforme orientação médica.

Alguns casos em que as consultas e exames auxiliam:

  • Para gestantes, os pré-natais diminuem a mortalidade  materna e fetal;
  • Consultas ao pediatra nos primeiros anos de vida do bebê;
  • Exames preventivos após os 50 anos para prevenção de câncer;
  • Exames preventivos na fase adulta tanto para homens quanto mulheres para detecção precocede câncer, doenças crônicas etc.
  • Por exemplo, segundo o INCA, as mulheres que realizam o exame de rotina do Papanicolau podem reduzir de 60% a 90% a incidência do câncer cervical invasivo. Em alguns países avançados este número chega na média a 80%4.
  • Apenas, ir a consultas médicas e realizar os exames não garante uma saúde adequada caso não implante bons hábitos como se alimentar com comida de verdade, reduzindo comidas industrializadas, fazer atividades físicas e evitar excesso de bebidas alcoólicas, abster-se de fumar, fugir das drogas pesadas.

7- Exames

Os exames são ferramentas importantes para o acompanhamento da saúde do indivíduo, como mencionado no tópico acima, e devem ser realizados com periodicidade, segundo recomendações dos especialistas.

Porém, exames feitos em excesso podem expor pacientes à risco por meio de radiação ou por serem invasivos.

Outro efeito colateral, são possíveis danos psicológicos ao paciente, pelo estresse que gera a expectativa dos resultados. O paciente pode manifestar ansiedade sempre antes de realizar os exames com medo de estar doente ou passar a buscar incansavelmente por um diagnóstico.

a. Validade dos exames e os riscos


Realize apenas exames quando o seu médico solicitar e se os últimos feitos perderam a validade.
Muitos pacientes não sabem, mas a maioria dos exames apresentam uma validade, normalmente de 6 meses (como exames de sangue), portanto não é necessário refazê-los nesse período.

Ao realizá-lo novamente o paciente está se expondo ao um risco, pois como dito anteriormente, seja de radiação seja pelos casos invasivos. Exemplo de exames invasivos: Raio-X, Tomografia computorizada, biópsia, endoscopia etc. Exames como esses que emitem radiação ou necessitam de um pequeno corte, anestesia, feitos com alta frequência podem trazer danos ao paciente.

Algumas complicações que podem acontecer no processo de biópsia que envolve anestesia: há riscos cardiopulmonares, arritmias, parada respiratória, reações anafiláticas devido ao uso de anestesia. Outros riscos da biópsia envolvem perfuração, sangramentos. Portanto, faça exames sempre que seu médico solicitar para confirmar diagnóstico de um problema que necessite de ações imediatas.

A responsabilidade do uso eficiente do plano de saúde está nas mãos do beneficiário

Como mencionando anteriormente o reajuste das mensalidades dos planos de saúde é influenciado pela frequência e custo dos procedimentos de saúde realizados pelos beneficiários. Esta cartilha recomenda que você faça os procedimentos conforme prescritos por seu médico.

O propósito desta cartilha não é convencer a não utilizar o plano, mas sim utilizá-lo sempre e somente na medida certa – nem mais, para que você não se exponha a efeitos adversos que podem prejudicar sua saúde, nem menos porque sua saúde pode piorar.

Em um tempo que se debate a sustentabilidade nas mais diversas áreas é importante abordarmos também a necessidade de sermos responsáveis em utilizar os recursos médicos de forma inteligente para que o maior número de pessoas tenha acesso com qualidade.

Referências

Agência Nacional de Saúde Suplementar: Declaração de Saúde. Disponível em: http://www. ans.gov.br/aans/index.php?option=com_centralde

Instituto de Estudo de Saúde Suplementar: Cartilha de Reajustes dos Planos de Saúde. Disponível em: https://www.iess.org.br/cms/rep/ cartilha-reajuste.pdf

Instituto de Estudo de Saúde Suplementar: Impacto do envelhecimento sobre as despesas assistenciais da Saúde Suplementar (2020-2031): Disponível em: https://www.iess.org.br/cms/rep/ TD79_Impacto_envelhecimento.pdf

Instituto Nacional de Câncer (INCA): Detecção precoce. Disponível em: https://www.inca. gov.br/controle-do-cancer-do-colo-do-utero/acoes- de-controle/deteccao-precoce

 

 

 

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