Health care agreements: a “zero-sum” game

Abstract

This paper deals with problems related  to health plans in Brazil. Due to the growing  demand for medical services provided by the  supplementary health market, coupled with the  development of medicine and an increase in  the life expectancy of the population, the contracts  between health plan operators and users  are in constant instability. Based on the social  function of the contract and the good faith, the  Judiciary Power intervenes in these contracts,  because health is a fundamental right. However,  health plan operators create strategies to escape  these interferences that alter the actuarial calculation  of these contracts, so that a ‘zero-sum’  game between operators and users is produced.  It appears that the health plan contract, based  on the insurance contract and, therefore, a  random contract, is on the way to becoming a  commutative contract because the scope of the  contract has been reduced significantly with the  inevitable demand for care in the area. In conclusion,  the solution involves both technological evolution and good faith to provide users with  transparency on what is actually spent by the  accredited network, making it possible to assess  what is received for what is paid.