Um estudo exploratório sobre a viabilidade de um modelo híbrido de plano de saúde com acumulação

Abstract

The objective of this study is to analyze the feasibility of a hybrid model of health insurance costing, where expenses throughout life are financed by the accumulation of resources during active life by the insured himself. We used microdata from the Health chapter of the National Household Sample Survey (PNAD) to quantify the annual frequency of medical appointments and hospital admissions, as well as the average income of potential insured persons. We also used the 2016 Pricing Panel from the National Agency for Supplementary Health (ANS), where we got information on the severity of events, that is, the average price of medical consultations and hospitalizations, by age group. We calculated the annual medical expenses of representative individuals, by gender and income range. We developed four accumulation models, respecting the principle of actuarial justice with regard to the relationship between payments and expenses. In the first, the contribution amount is fixed. In the second, the contribution is defined as a fixed percentage of the insured's income. In the third, the rates increase throughout life. In the fourth model, in addition to financing health expenses, the amount accumulated by the insured is also used to pay him an annuity at the end of his active life. The results show that the product is not viable in most of the analyzed cases. The only exception were high-income individuals, who allocated less than 20% of their income to medical expenses, in all methods.