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

Authors

  • Daniela Batalha TRETTEL Universidade de São Paulo. São Paulo/SP.
  • Juliana Ferreira KOZAN Universidade de São Paulo. São Paulo/SP.
  • Mario César SCHEFFER Universidade de São Paulo. São Paulo/SP.

DOI:

https://doi.org/10.11606/issn.2316-9044.v19i1p166-187

Keywords:

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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Author Biographies

  • Daniela Batalha TRETTEL, Universidade de São Paulo. São Paulo/SP.

    Pós-Doutora pelo Programa de Medicina Preventiva na Faculdade de Medicina da Universidade de São Paulo (USP); doutora e mestre em Direitos Humanos pela Faculdade de Direito da USP. Defensora Pública do Estado de São Paulo. 

  • Juliana Ferreira KOZAN, Universidade de São Paulo. São Paulo/SP.

    Mestranda do Programa de Medicina Preventiva na Faculdade de Medicina da Universidade de São Paulo; especialista em Direito Administrativo pela Faculdade Autônoma de Direito. Advogada. 

  • Mario César SCHEFFER, Universidade de São Paulo. São Paulo/SP.

    Professor Doutor do Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo. 

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Published

2018-07-13

Issue

Vol. 19 No. 1 (2018)

Section

Argument

License

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

How to Cite

TRETTEL, D. B., KOZAN, J. F., & SCHEFFER, M. C. (2018). 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. Journal of Health Law, 19(1), 166-187. https://doi.org/10.11606/issn.2316-9044.v19i1p166-187