Voltar
Voltar
A judicialização da saúde deixou de ser exceção e tornou-se uma realidade que impacta diretamente o fluxo financeiro das operadoras. Segundo o CNJ, ações judiciais cresceram 16%, passando de 295.920 em 2022 para 344.211 em 2023, e já superaram 345 mil entre janeiro e novembro de 2024. Grande parte das demandas envolve negativas de cobertura, reajustes contratuais e terapias fora do Rol da ANS. Liminares concedidas sob pena de multa diária geram custos imprevistos, comprometendo o cálculo atuarial.
Além dos custos diretos, que alcançaram R$ 5,5 bilhões em 2023, depósitos judiciais chegaram a R$ 2,67 bilhões até setembro de 2024, reduzindo liquidez e elevando o risco de intervenção da ANS. Embora as operadoras tenham registrado lucro líquido agregado de R$ 8,7 bilhões até o terceiro trimestre de 2024, decisões desfavoráveis podem rapidamente reverter esse cenário, somando-se multas de até R$ 1 milhão por infração e possíveis regimes especiais de direção fiscal.
Jurisprudencialmente, o STF estabeleceu parâmetros importantes nos Temas 6 (RE 566471) e 1234 (RE 1.366.243), limitando o fornecimento judicial de medicamentos não incorporados ao SUS e concentrando essas ações contra a União, destacando o papel técnico da Anvisa e Ministério da Saúde. Operadoras devem atuar como amicus curiae para preservar o equilíbrio contratual.
Para gestão estratégica, recomenda-se revisar contratos conforme RN 465/2021, esclarecendo limites de cobertura e reajustes; criar comitê técnico-jurídico multidisciplinar para avaliações fundamentadas; incentivar mediação pré-judicial para reduzir custos; segregar provisões específicas e monitorar sinistralidade extraordinária; além de participar ativamente dos leading cases.
Nesse contexto estrutural, o departamento jurídico passa a ter papel estratégico na sustentabilidade econômica das operadoras e na promoção de um sistema mais previsível e seguro para todos os envolvidos.
Title text modal
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using 'Content here, content here', making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for 'lorem ipsum' will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).
- Assessoria de imprensa:
-
imprensa@nwadv.com.br