By Brazil Stock Guide – Brazil’s National Supplementary Health Agency, known as ANS, has begun discussing the creation of a dedicated oversight framework for the Unimed System, as it seeks to strengthen governance and prevent financial or operational problems at individual cooperatives from developing into broader crises.
The proposal was presented at a meeting of the agency’s board last week and remains at an early stage. It does not change any existing rules or create immediate obligations for the cooperatives. It does, however, reflect growing concern at ANS over the stability of a system that serves about 20 million people and accounts for roughly 40% of Brazil’s private health plan market.
Contrary to a common perception, Unimed is not a single company. It is a cooperative network comprising 336 independent medical cooperatives. Each has its own management, assets and registration with ANS, but all operate under the same brand and are organized across three levels: local cooperatives, known as singulares; state federations; and Unimed do Brasil, which coordinates the system nationally. Although legally independent, the cooperatives are closely connected operationally, particularly through an exchange network that allows members to receive care in different parts of the country.
That combination of legal independence and operational interdependence lies at the heart of the regulator’s concerns. Problems at one cooperative can affect payments between Unimed entities, relationships with hospitals and physicians, continuity of care and the reputation of the entire system.
During the presentation, Jorge Aquino, ANS’s director responsible for health plan operator standards and licensing, said the agency had identified “anomalies” and the risk that isolated difficulties could generate systemic consequences. According to Aquino, the traditional regulatory model, which is largely based on intervention after problems have already emerged, may be approaching its limits.
The proposal under consideration would replace part of that reactive approach with a more preventive form of supervision. ANS is considering entering into a Technical Cooperation Agreement with Unimed do Brasil, under which the national organization would take a more active role in monitoring the cooperatives that make up the system.
That work could include monitoring governance standards, conducting prudential oversight of individual cooperatives, requiring remediation plans, mediating disputes, developing mechanisms to distribute losses and preparing contingency plans for situations in which access to healthcare services is at risk.
ANS would retain responsibility for government oversight, enforcement, sanctions and the system’s ultimate supervision. The change would create an initial layer of monitoring within Unimed itself, allowing problems to be identified and addressed before they develop into financial or healthcare crises.
Aquino compared the proposed structure with arrangements used in Brazil’s financial system. Credit cooperatives are monitored by their confederations, while the Central Bank supervises the system as a whole. He also cited cooperation agreements between the Brazilian Securities and Exchange Commission, or CVM, and capital-markets association Anbima as an example of supervised self-regulation.
According to Aquino, the proposal would not transfer any of ANS’s legal responsibilities or outsource regulatory enforcement. Its purpose would be to strengthen the agency’s preventive capabilities and reduce the administrative burden involved in supervising hundreds of interconnected cooperatives individually.
The agreement would not involve the transfer of financial resources. Each party would bear its own costs, and the partnership would not create joint or secondary liability between ANS and Unimed do Brasil.
The discussion gained additional weight when ANS President Wadih Damous said that, since he joined the agency, the Unimed System had been the segment generating the greatest number of complaints, concerns and crises.
Damous recalled that he took office during the collapse of a Unimed cooperative in Rio de Janeiro. He also said he had received reports that the structure responsible for ensuring continuity of care for affected members was itself experiencing difficulties in its dealings with healthcare providers. He cautioned, however, that those reports still needed to be verified.
According to Damous, the system could face a much broader crisis if the problems cease to be isolated and become more widespread. He described the discussion over Unimed’s governance as both “promising and necessary.”
The agency’s assessment does not mean that all Unimed cooperatives are experiencing difficulties. Many have solid financial positions and strong operating indicators. The concern is that, because they share the same brand and exchange network, problems at individual cooperatives can have consequences that extend beyond their own legal and geographic boundaries.
ANS also highlighted the difficulty of holding the national organization accountable for problems at local cooperatives. Although Unimed do Brasil controls the brand, coordinates the exchange network and has internal supervisory and disciplinary mechanisms, each cooperative retains its legal and financial autonomy.
The proposed cooperation agreement is intended to increase the national organization’s responsibility for the stability of the system as a whole, without eliminating the autonomy of the individual cooperatives or replacing ANS’s regulatory role.
The initiative must still undergo legal review, further discussion among the agency’s directors and the preparation of a detailed work plan. Any final agreement would have to return to the ANS board for approval.
Should the proposal move forward, it could represent a significant change in the supervision of Brazil’s largest cooperative healthcare network. ANS would begin treating Unimed not merely as a collection of independent health plan operators, but as a highly integrated system in which preventing systemic risks may be just as important as enforcing rules against individual failures.
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