Sign in Subscribe
Health care industry

Managed Care Research Reveals High Success Rate for Patients in Private Health Insurance Sector in Brazil

Strategic Insights

— 1 min read

Researchers from Law School analyzed 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. The findings showed that courts decided 83.6% of cases in favor of patients, ordering VHI companies to fully fund the claimed treatment. Additionally, patients had a higher success rate (96%) in cases where insurance companies denied coverage due to the treatment not being listed in the benefits package mandated by regulation.

Key Takeaways:

  • The study analyzed 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 favor of patients, ordering VHI companies to fully fund the claimed treatment.
  • Patients had a higher success rate (96%) in cases where insurance companies denied coverage due to the treatment not being listed in the benefits package mandated by regulation.
  • The study suggests that courts have been presenting additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector.
  • The research has broader implications for healthcare equality and access in Brazil.
  • Specific insurance companies were not mentioned in the study, but the research suggests that patients have a high success rate in cases against private insurance companies in Brazil.

Statistics:

  • 1,547: The number of court of appeal decisions analyzed in the study.
  • 83.6%: The percentage of cases decided in favor of patients, ordering VHI companies to fully fund the claimed treatment.
  • 96%: The success rate of patients in cases where insurance companies denied coverage due to the treatment not being listed in the benefits package mandated by regulation.
  • 2018-2021: The time period during which the court of appeal decisions were made under analysis.

Sources:

  • Judicial Claims for Access To Treatment In the Private Health Insurance Sector In Brazil. Health Economics Policy and Law, 2025.
  • Law School, Sao Paulo, Brazil.
  • Daniel Wei Liang Wang, Fgv Sp, Law School, Sao Paulo, Brazil.
  • Ezequiel Fajreldines dos Santos, Bruno da Cunha de Oliveira, Jacqueline Leite de Souza, Natalia Pires de Vasconcelos, Fernanda Mascarenhes de Souza, Nathalia Molleis Miziara, Luisa Bolaffi Arantes, and Ana Maria Malik.

Read more