We were told we would never be the same after the pandemic. Healthcare, at least, could not afford to be. Yet in Brazil’s private health plan market, one of the most obvious lessons of Covid-19 still seems only partly absorbed: operators remain better at paying for consultations, tests, hospital stays and surgeries than at following the patient’s journey.
The pandemic should have ended the illusion that healthcare can be managed as a sequence of isolated events. A patient falls ill, seeks care, undergoes tests, is admitted to hospital, receives treatment, is discharged and goes home. In many cases, however, no one seems clearly responsible for continuity of care. The system records the bill. It does not always follow what happened to the patient.
The question that still dominates the industry is: who pays the bill? The question that should dominate it is different: who takes care of the patient?
This is not a small problem. Brazil’s supplementary health system covers about 53 million people in medical plans, roughly a quarter of the population. It is also a nearly R$400 billion industry: in 2025, the sector posted R$391.6 billion in total revenues and R$24.4 billion in net income.
Those numbers show the scale of the challenge. Over the past three decades, Brazil has made significant progress in regulating health plan contracts. The country’s Health Plans Law moved the sector away from a world in which coverage, waiting periods, exclusions and deadlines were far less clear. It created standards, made products more comparable, established minimum rights and allowed consumers to better understand what they were buying.
That first chapter was necessary. But it is no longer enough.
The real challenge now is not only to ensure that a procedure is covered. It is to know whether the patient is being cared for in a coherent way before, during and after illness. Brazil’s private health plan sector still operates, to a large extent, as a financial intermediary between the beneficiary, the hospital, the doctor and the laboratory. It authorizes, denies, audits and pays claims. It adjusts prices and discusses medical loss ratios. But it is rarely held transparently accountable for the clinical outcomes it delivers.
This explains one of the sector’s biggest distortions. Health plan operators know a lot about costs, networks, deadlines, utilization and procedure frequency. They know less about what all of that actually produced. Did the patient get better? Was there an avoidable readmission? Was a diabetic patient properly monitored before an amputation? Was a hypertensive patient controlled before a stroke? Was there continuity of care after hospital discharge? Does the operator know what happened after surgery?
Without those answers, competition is poor. Consumers choose health plans based on price, brand, provider network, advertising or reputation. But they cannot easily and reliably compare which operator delivers better care. A plan with a broad network may offer a poor patient experience. An expensive plan may have weak care coordination. A plan that is efficient in reducing waste may simply be seen as restrictive. Without outcome indicators, everyone discusses cost — and almost no one discusses value.
The difficulty is that measuring care changes the economic incentives of the entire chain. Hospitals are paid for beds, procedures and complexity. Laboratories are paid for tests. Doctors are often paid by event. Operators try to control claims. Patients want fast access. The regulator tries to balance consumer protection with the financial sustainability of the operators. Each link sees one part of the problem. There are exceptions, but few actors are responsible for the whole.
Integrated care requires a different logic. It requires coordination, shared data, chronic disease management, prevention, risk management and outcome indicators. It requires the operator to stop being merely the company that pays the bill and become co-responsible for the care it organizes.
That is an easy change to describe. It is a much harder one to execute.
Prevention, for example, costs money today and saves money tomorrow. An operator may invest in monitoring a chronic patient to avoid a hospitalization five years from now. But that beneficiary may switch plans before then. In 2024, Brazil’s supplementary health system recorded 16.4 million new enrollments and 15.6 million cancellations in medical plans, a turnover rate of 30.5%. Almost a third of all relationships were replaced over the course of the year. The company that pays for prevention today may not be the one that captures the savings tomorrow.
There is also a natural resistance to transparency. Measuring outcomes means comparing performance. Comparing performance means exposing it. Which operator has more readmissions? Which network produces more complications? Which plan better follows chronic patients? Which hospital discharges patients without continuity of care? Those data would change reputations, bargaining power, regulatory scrutiny and consumer choice.
Technology makes this shift more possible than it was in the past. Digital medical records, integrated databases, artificial intelligence, Brazil’s data protection law and the National Health Data Network create conditions to better understand the patient journey. Brazil now has tools that did not exist when the regulatory framework was created. In theory, it should be possible to connect information from hospitals, laboratories, doctors, operators and the public health system to build a fuller picture of population health.
But technology alone does not solve an incentive problem.
Congress, meanwhile, tends to respond to the problems of health plans through specific obligations: a new mandatory coverage, a new deadline, a new limit on denials, a new reimbursement rule. Many of these demands come from real problems. Consumers are often the weaker party in the relationship. But healthcare is a system of communicating vessels. A new coverage requirement imposed without proper impact analysis can raise costs, pressure premiums, reduce access and increase litigation.
Protecting consumers requires more than expanding rights on paper. It requires designing incentives so that the system delivers better care, with less waste and more coordination. Otherwise, the bill returns to the beneficiary in the form of higher premiums, narrower networks or lawsuits.
The next phase of Brazil’s private health plan market should not be defined only by the list of covered procedures. It should be defined by the ability to turn coverage into care. That means measuring outcomes through the quality of assistance delivered.
The health plan of the future cannot be just a card that authorizes tests and surgeries. It will have to become a care engine — a true health manager. The next leap for Brazil’s supplementary health system will depend on answering a simple and uncomfortable question: after the patient leaves the hospital, who keeps caring for them?
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