The institutional interface between Brazilian Regulatory Agency for Private Health Insurance and Judiciary: analysis of judicial cases about medical care for emergencies in healthcare plans

Abstract

This article makes a descriptive analysis of judicial review of the regulations adopted by the Brazilian National Regulatory Agency for Private Health Insurance and Plans (ANS – in Portuguese) in relation to cases involving emergency coverage to health care plans users. Thus, it was made a review of judgments from courts of the states of São Paulo, Rio de Janeiro and Minas Gerais that focused on this topic and, as a result, it was found that the regulatory standard has been declared illegal by most members of these courts (except for a specific section in the Court of São Paulo). The results were discussed, based on the levels of judicial intervention and highlighting epistemic problems for the characterization of a medical emergency, as well problems to define its limits. As a conclusion, it was shown there is a clear need for a better regulatory standards and a harmonious institutional interface between the regulatory agency and the judiciary.