巴西私营医疗保险部门获得治疗的司法索赔。

IF 3 3区 医学 Q2 HEALTH POLICY & SERVICES
Daniel Wei Liang Wang, Natalia Pires de Vasconcelos, Ezequiel Fajreldines Dos Santos, Fernanda Mascarenhas de Souza, Luísa Bolaffi Arantes, Nathalia Molleis Miziara, Bruno da Cunha de Oliveira, Jacqueline Leite de Souza, Ana Maria Malik
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引用次数: 0

摘要

虽然文献主要集中在公共医疗配给决定的法律挑战,对自愿健康保险(VHI)计划中的私人保险公司的索赔受到的关注较少。本文旨在通过分析2018年至2021年巴西针对私营保险公司提出的治疗资金索赔的1547个上诉法院判决的代表性样本来填补这一空白。法院判决83.6%的案件有利于患者,命令VHI公司全额资助所声称的治疗。如果保险公司以声称的治疗未列入法规规定的福利计划为由拒绝承保,患者的成功率甚至更高(96%)。法院的裁决对通过卫生技术评估和艾滋病毒感染者保健部门的明确一揽子计划确定优先事项提出了新的挑战。这对巴西的卫生保健平等和可及性具有更广泛的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Judicial claims for access to treatment in the private health insurance sector in Brazil.

While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.

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来源期刊
Health Economics Policy and Law
Health Economics Policy and Law HEALTH POLICY & SERVICES-
CiteScore
5.30
自引率
0.00%
发文量
55
期刊介绍: International trends highlight the confluence of economics, politics and legal considerations in the health policy process. Health Economics, Policy and Law serves as a forum for scholarship on health policy issues from these perspectives, and is of use to academics, policy makers and health care managers and professionals. HEPL is international in scope, publishes both theoretical and applied work, and contains articles on all aspects of health policy. Considerable emphasis is placed on rigorous conceptual development and analysis, and on the presentation of empirical evidence that is relevant to the policy process.
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