By Brazil Stock Guide – Brazil’s private health plan regulator, the Agência Nacional de Saúde Suplementar (ANS), released on Tuesday (Dec. 23) the results of the 2025 Supplementary Health Performance Index (IDSS), based on 2024 data, showing a modest but broad-based improvement in quality across the country’s private health plan market. A total of 873 health plan operators were assessed, and the sector’s weighted average score — adjusted by the number of beneficiaries — reached 0.7930, up 0.0125 from the previous year, on a scale ranging from zero to one.
According to the regulator, 75.6% of operators achieved scores above 0.6, placing them in the two highest IDSS performance bands. Scores above 0.8 represent top-tier performance, while results between 0.6 and 0.8 indicate solid, though less differentiated, operational standards. The improvement comes alongside tighter oversight and methodological refinements, with 11 indicators updated to better reflect service quality and execution by health plan operators.
Segment-level results show broadly consistent performance. Among 219 dental-only health plan operators, 80.8% ranked in the two highest bands. In the larger medical-hospital segment, comprising 654 operators, 73.9% reached the same threshold — in line with the overall market average.
Large Operators Under the Microscope
Beneath the aggregate improvement, results among Brazil’s largest health plan operators reveal meaningful dispersion. Bradesco Saúde posted an IDSS score of 0.8112, remaining in the top performance band and reinforcing its reputation for operational consistency within a tightly regulated market.
Sul América Saúde followed closely, with a score of 0.8297, placing it near the top of the national ranking and highlighting the strength of its governance framework and service delivery model among large, non-verticalized operators.
Among group medicine operators, Amil Assistência Médica Internacional recorded an IDSS score of 0.8300, also within the highest performance band. The result stands out given the company’s complex corporate structure and the fact that several Amil-related entities did not have individual scores calculated in the index.
Performance was more restrained among vertically integrated operators undergoing operational adjustment. Hapvida Assistência Médica posted an IDSS score of 0.7693, remaining in the second-highest band but below the sector average. The outcome reflects execution challenges linked to rapid expansion and hospital openings, even as the company continues to argue that vertical integration delivers long-term efficiency and cost control.
The strongest scores among large operators came from the cooperative segment. Unimed Belo Horizonte and Unimed Porto Alegre both achieved the maximum IDSS score of 1.0000, placing them at the very top of the national ranking. Their performance underscores how localized governance, tighter network control and operational focus can translate into superior quality outcomes within Brazil’s health plan system.
Accreditation as a Structural Divider
Accreditation remained a key differentiator in the 2025 cycle. Accredited health plan operators posted an average IDSS score of 0.8401, even without accounting for bonus points tied to certification, compared with 0.7703 for non-accredited peers. Despite representing just 12.26% of beneficiaries in the medical-hospital segment, accredited operators continue to define the upper bound of performance in the market.
Regulators argue that the gap reflects tangible differences in management discipline, care coordination and preventive health strategies, reinforcing accreditation as a proxy for operational maturity in Brazil’s private health plan industry.
A Market-Wide Signal
The IDSS evaluates all active health plan operators annually and compulsorily using 33 indicators across four dimensions, covering the full scope of operations. The index plays a central reputational and regulatory role in a system that serves 53.3 million beneficiaries in medical-hospital health plans and 35.1 million beneficiaries in dental-only plans — together covering more than a quarter of Brazil’s population.
Health plan operators are required to disclose their individual results by January 22, 2026, and may file appeals between December 24 and January 7. For investors, regulators and policymakers, the 2025 IDSS results point to a market gradually converging toward higher standards — while still marked by clear winners, laggards and structural trade-offs between scale, integration and quality.
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