Private hospitals slow expansion due to lack of resources – 01/07/2024 – Market

Seven out of ten top hospitals in the country were unable to execute their investment plans for expansion (72.6%) and new hires (70.6%) in 2023 due to lack of financial resources. Almost two thirds (63.5%) also did not invest in renewing their technology parks.

The scenario is shown in an unprecedented survey by Anahp (National Association of Private Hospitals) with 66 associated institutions, carried out in the first week of December. The estimate is that R$3.6 billion was not invested last year.

According to Antônio Britto, executive director of Anahp, one of the main reasons for the squeeze is the crisis faced by the supplementary health system, which has caused delays in payments by health plans. These are invoices referring to services provided by hospitals to plan beneficiaries, such as emergency care, surgeries, exams and other procedures.

Another survey with 48 hospitals released by Anahp last September showed that these delays totaled R$2.3 billion — equivalent to 16% of revenue in the period. The entity brings together 122 hospitals of excellence, including Albert Einstein, Sírio-Libanês, Oswaldo Cruz, Hcor, Nove de Julho and Copa D’Or and has almost a 25% share in assistance expenses in supplementary health.

Another point of tension between hospitals and operators has been the increase in glosses, which are questions made by operators to invoices sent by hospitals. The rate had a historical standard of 3.5% of gross revenue and last year it rose to 9%, according to Anahp.

Most of the hospitals interviewed (42.5%) foresee stability in investments this year, 15.3%, a reduction, and 11.5% do not plan new investments. Less than a third (30%) say there will be an increase.

According to Britto, another cause for the reduction in investments in 2023 was the high basic interest rate (Selic). In 2022, it had closed at 13.75% and remained at this level until June 2023, when it started to fall and ended the year at 11.75%.

In general, part of hospitals’ investments come from bank loans. “With the very high interest rate, there was a greater fear of seeking money from banks”, he says.

The drop in investments also affects the maintenance and conservation of hospital equipment. “We are not talking about hospitals having difficulty growing. The difficulty is in maintaining what we have”, says the director of Anahp.

The smaller the hospital, the greater the impact on investment capacity, according to Britto. “Anahp has hospitals that are in the upper third of the Brazilian hospital structure. The reality of the group of Brazilian hospitals, Santas Casas and small hospitals, must be even worse.”

Francisco Balestrin, president of Sindhosp (union of hospitals, clinics and laboratories in São Paulo), corroborates this perception. According to him, smaller hospitals, which are not part of large networks, are suffering more from late payments and the reduction in authorizations for procedures by health operators.

“Many hospitals are leveraged [endividados]. They sought resources in the financial market and, in order to pay the banks, they depend on what they produce. But they are finding these offenders [atrasos de pagamentos por parte das operadoras]”, he explains.

Balestrin states that there are rumors in the market that the increase in monthly health plan fees this year is expected to be between 20% and 25%, but he says that these adjustments do not reach service providers. “No health institution has managed to negotiate adjustments even close to these levels.”

For him, the scenario in 2024 should be similar to that recorded in 2023 in relation to investments. “Nothing indicates that payment terms will improve, that disallowances will improve and that negotiations with operators will improve.”

Britto is a little more optimistic. He says that in recent months there has been a slight improvement in indicators. “But this does not mean that the true causes of the problem are being addressed. They arise from structural factors that will only be overcome with the adoption of reforms in the supplementary healthcare system.”

According to him, there is unanimity in the sector that a series of changes are necessary. Among them, mutual trust and joint actions between providers and operators, such as prevention and health promotion, data interoperability, changing the remuneration model, use of indicators to evaluate hospitals and expansion of telemedicine.

In a note, Fenasaúde (National Supplementary Health Federation) says it considers the interpretation that health plan operators contributed to the lack of investment in hospital structure to be a distortion. “It is up to each business group to define its own business strategy.”

According to the federation, data from the ANS (National Supplementary Health Agency) indicate that, from 2018 to 2022, the amount paid by health plan operators to private hospitals, considering only hospitalizations, grew by 40%.

“Only in 2022 [dados mais recentes disponíveis] there were R$95 billion, with more than 8.7 million clinical, surgical, obstetric, pediatric and psychiatric hospitalizations recorded.”

According to Fenasaúde, disallowances are never practiced by operators on a discretionary basis, occurring only when non-conformities are identified in the billing processes, such as wrong codes, incomplete data, insufficient documentation, prices incompatible with those practiced in the market and charges for items already included in fees and daily rates.

It also informs that, according to ANS data, in the first half of 2023, the average time elapsed between the presentation of charges by service providers and payment by health plan operators was around 30 days, with glosses representing a percentage of 7.5% of the value of services provided.

Also note, Abramge (Brazilian Association of Health Plans) says it is unaware of the existence of undue payment disallowances. “This is a one-on-one relationship between companies and their suppliers.”