Judicialization of collective health insurance plans: The effects of the Brazilian National Regulatory Agency for Private Health Insurance and Plans regulatory choice in conflicts between consumers and private health insurance providers
DOI:
https://doi.org/10.11606/issn.2316-9044.v19i1p166-187Keywords:
Health Insurance, Jurisprudence, Regulation, Supplementary Health.Abstract
This study aims to approach judicialization in private health insurance through the analysis of lawsuits contained in the public online database of the Court of Justice of the State of São Paulo. Through the application of a form, 4,059 lawsuits were analyzed, all related to collective contracts of private health insurance, filed in the city of São Paulo during 2013 and 2014. Besides of quantifying and describing the profile of the demands brought to justice, a qualitative analysis of judicial decisions was performed. The study identified the main issues judicialialized as coverage reductions, the maintenance of members of collective contracts even after retirement, and increases in monthly payments for members as they become older and charges for increased risk. Concluding that regulations and jurisprudence are discordant, the study suggests regulatory changes aiming at the reduction of conflicts that permeate the private health insurance market.
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The Revista de Direito Sanitário/ Journal of Health Law adopts the conditions of the Creative Commons Attribution 4.0 Internacional. This license allows to share - "copy and redistribute the material in any medium or format for any purpose, even commercially" and adapt - "remix, transform, and build upon the material for any purpose, even commercially." Details at: https://creativecommons.org/licenses/by/4.0/deed.en