Agência Nacional de Saúde Suplementar. estudo do caso da incorporação de tecnologias de saúde entre 2007 e 2016: uma análise desenvolvida pelo modelo de coalizão de defesa

Abstract

The guarantee of adequate and quality care coverage for health plan users is a legal attribution of the National Supplementary Health Agency - ANS. Among the responsibilities of the regulatory agency, which contribute to this task, is the elaboration and updating of a list of procedures of minimum mandatory coverage, by the health insurance operators operating in Brazil. It is through the periodic modification of the ANS list that the incorporation or exclusion of technologies in the supplementary health sector occurs. This subject directly mobilizes the interest of several actors in this segment such as professionals, health insurance companies and their users, consumer protection agencies and the hospital materials and medicines industry. In order to understand how the policy of incorporation of technologies in supplementary health evolved from the updating of the list of procedures and health events in the ANS, from 2007 to 2016, this doctoral thesis used as a theoretical framework the Advocacy Coalition Framework, by Paul Sabatier and Jenkins-Smith, and proposed to identify, describe and analyze the main actors, the beliefs of the political core, the coalitions, the learning and the changes that occurred in the political subsystem in focus. In order to undertake this task, a qualitative exploratory research was carried out, based on the documentary analysis of the records available on the ANS website, such as meeting minutes, documents of presentations made at these meetings and pages of the World Wide Web. To complement the documentary analysis, interviews were conducted with individuals who participated in the process of updating the ANS list in the period analyzed. The structuring of the technology incorporation policy, through the updating of the ANS list, in the time interval studied, occurred from the interaction of coalitions and potential coalition members who acted in defense of their interests, providing political learning and gradual changes driven mainly by the introduction of knowledge in Health Technology Assessment (HTA). Scientific knowledge played a relevant role in guiding the debates and was reflected in the way the structures, rules and methodologies used by ANS were created. The interaction of the regulatory agency with the health technology assessment policy of the Unified Health System - SUS was important for the structuring of this process in the supplementary sector. National and international organizations with experience in health technology assessment, as well as scientific databases and medical specialty societies, were some of the sources of information that allowed the gradual construction and implementation of a policy for the incorporation of technologies in supplementary health. The two coalitions identified had as their main divergence the criteria used to decide on the inclusion of technologies in the ANS list. On the one hand, the medical specialty societies defended the care variables as determinants for the inclusion of technologies, while the health plan operators argued insistently in favor of the economic and financial viability of the incorporations. In harmony with the historical trajectory of the ANS, the financial impact of technology inclusions was not disregarded, but the care aspects were prioritized.