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011 Methodological Issues Related To Mandatory Coverage Policies of the Brazilian Regulatory Agency (ANS) To Be Followed By Brazilian Private Health Plans (BPHP)
  1. M Cabanelas Pazos,
  2. S Alves da Silva,
  3. P Pereira de Souza,
  4. P Rascão Cardoso
  1. Amil Assistencia Médica Internacional, Rio de Janeiro, Brazil

Abstract

Context Brazilian private health plans (BPHP) are regulated by ANS mainly through a list of procedures for mandated coverage, some of which are supported by guidelines formulated by Medical Societies. Where guidelines exist quality varies widely. Penalties imposed on BPHP by ANS have frequently involved coverage mandates not supported by guidelines. An example is treadmill testing, which is ordered more often than can be administered to patients due to lack of providers. A dialogue for collaboration on specific issues between Brazil’s largest health plan and the regulatory agency started in 2012.

Description of Best Practice Four areas of interest were selected based on 1)high economic impact; and 2) utilisation issues: cardiovascular and genetic testing, neurosurgery and oncologic procedures. ANS interest focuses on new technologies to be addressed in the upcoming revision of the mandatory coverage list. We used the AGREE II instrument to identify inconsistencies in the ANS guidelines. Most weaknesses related to “Rigour of development” issues.

Lessons for Guideline Developers, Adaptors, Implementers, and/or Users Brazilian regulators currently seek improved criteria for regulation of health technologies. Independently developed guidelines are sparsely used by regulators in Brazil. We initiated a public-private partnership which brings methodological standards to the table such that scientifically sound guidelines may play an enhanced role in Brazilian regulatory policy. Such a step may increase appropriate utilisation of resources and diminish penalties applied by ANS due to requests not supported by scientific- evidence. Full development of the partnership will require participation of the medical societies.

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