Private Health in Brazil Customer Challenges and Pains Analysis¶
Challenges and Pains faced by Customers¶
Based on the analysis of the provided reports on the Brazilian private health industry's value chain, final customers predominantly drawn from higher-income and growing middle-class households face several key challenges and pains. While seeking advantages over the public health system (SUS) such as shorter waiting times, wider provider choice, and perceived quality, beneficiaries of private health plans and those paying out-of-pocket encounter significant hurdles within the private system itself.
The most prominent pain point for customers is Premium Affordability and High Costs. Driven by medical cost inflation that outpaces general economic inflation, the cost of private health plans continues to rise. The methodology used by the regulatory body, ANS, to cap price adjustments struggles to balance consumer protection with the financial needs of operators, often resulting in substantial premium increases for beneficiaries. This directly impacts customers' ability to afford and maintain their private health coverage, potentially leading to downgrades in plans or even withdrawal from the private system.
Another significant challenge is related to Access Limitations, specifically concerning Regional Service Gaps and the Human-Capital Shortage. Despite the extensive private network, regional disparities in the distribution of healthcare infrastructure, such as private hospital beds, are pronounced. Customers in the North and rural Midwest regions, for instance, have significantly less access to private hospital beds per inhabitant compared to those in more developed states like São Paulo. Compounding this is a projected shortage of key healthcare professionals, such as intensivists and nurses, and their uneven distribution, which exacerbates regional inequities and can make it difficult for customers to access specialized care when and where they need it.
Customers may also face Access Delays to New Treatments and Technologies. Bottlenecks in the regulatory process, such as potential delays in device approval timelines at ANVISA due to staffing issues, can slow down the market entry of innovative therapies and medical technologies. Furthermore, the time it takes for the ANS to assess and include novel procedures in the mandatory coverage list (Rol de Procedimentos) can delay beneficiaries' access to advanced medical interventions, even if they are available in the market.
Finally, customers can experience Bureaucracy and Process Friction within the system. Although not as heavily emphasized as costs and access, the complex processes involving authorization for procedures and potential audit protocols embedded in the commercial relationships between health plan operators and providers can translate into administrative burdens and frustrations for customers navigating the system to receive care.
Prioritized table of challenges and pains
Based on the direct impact on the final customer and the emphasis in the provided texts, the challenges and pains can be prioritized as follows:
| Priority | Challenge/Pain | Description |
|---|---|---|
| 1 | Premium Affordability / High Costs | Rising costs of health plans and services straining customer budgets. |
| 2 | Access Limitations (Regional Gaps, Human-Capital Shortage) | Difficulty accessing healthcare services and specialized professionals, particularly in certain geographic regions. |
| 3 | Access Delays to New Treatments/Technologies | Delays in the availability and coverage of innovative medical products and procedures due to regulatory and coverage list processes. |
| 4 | Bureaucracy / Process Friction | Administrative hurdles related to authorizations, claims, and navigating the healthcare system. |
Correlation with Value Chain¶
These customer challenges and pains are deeply correlated with specific steps and dynamics within the Brazilian private health value chain:
- Premium Affordability / High Costs: This pain point is directly linked to the Financial Intermediation step, where health plan operators and insurers determine premiums. However, it is significantly influenced by costs generated across the entire chain, including the Supply of Health Products and Technology (cost of medicines and devices), Healthcare Services (provider fees and utilization), Distribution (logistics costs), and the overhead associated with Regulation. The commercial relationships between operators and providers, particularly regarding reimbursement models, also play a crucial role in cost structures that are eventually passed on to the customer.
- Access Limitations (Regional Gaps, Human-Capital Shortage): These challenges are most directly manifested within the Healthcare Services step, as they pertain to the availability of hospitals, clinics, and qualified professionals. The Research and Education step is indirectly correlated, as it is responsible for training future healthcare professionals. The financial viability of providers, influenced by Financial Intermediation (reimbursement rates), also impacts their ability to establish and maintain services in different regions. Distribution networks for supplies and equipment are also essential for enabling services in all locations.
- Access Delays to New Treatments/Technologies: This pain is correlated with the Supply of Health Products and Technology step (availability of products from manufacturers/importers), but crucially bottlenecked by the Regulation step (ANVISA and ANS approval and coverage inclusion processes). The speed and efficiency of these regulatory bodies directly impact how quickly customers can benefit from medical advancements.
- Bureaucracy / Process Friction: This challenge is primarily associated with the interactions between customers, Financial Intermediation (health plan operators), and Healthcare Services providers. The complexity of authorization processes, billing, and claims processing, defined within the commercial relationships and overseen by Regulation (ANS rules), contributes to customer frustration.
Understanding these correlations is vital for addressing customer pains effectively, as solutions often require interventions spanning multiple steps of the value chain, from regulatory reform and supply chain optimization to changes in payment models and investment in healthcare infrastructure and training.
References¶
Agência Gov. Março de 2024: planos de assistência médica somam mais de 51 milhões de usuários. 6 May 2024. https://agenciagov.ebc.com.br/noticias/202405 Agência Nacional de Saúde Suplementar (ANS). ANS divulga dados de beneficiários em novembro de 2024. 3 Jan 2025. https://www.gov.br/ans/pt-br/acesso-a-informacao/beneficiarios CNseg. Planos de saúde alcançam 51 milhões de beneficiários em janeiro de 2024. 14 Mar 2024. https://cnseg.org.br/noticias/planos-51-milhoes ISTOÉ DINHEIRO. Planos de saúde ganham mais de 860 mil clientes em 2024. 5 Feb 2025. https://www.istoedinheiro.com.br/planos-de-saude Value Chain Analysis Report on the Private Health Industry in Brazil.