Article type
Abstract
"Background: The National Supplementary Health Agency (ANS) regulates Brazil's private health insurance sector. Unlike established guidelines in the public health system, ANS has ""usage guidelines (DUT)"", which consider strict criteria, such as clinical condition, age, and sex, for health insurance coverage. There are currently about 230 DUTs, including drugs, devices, and surgical and clinical procedures for diagnosing, managing, and monitoring medical conditions. These documents should be updated to reflect new evidence and potentially redefine the eligible population.
Objectives: Description of the DUT update procedure implementation and the expected results.
Methods and expected results: In addition to GRADE recommendations, the DUT updating method will observe the following actions. ANS will first identify and rank the themes that will be the focus of quick evidence mapping and feasibility analysis. This list of themes will be subject to public consultation, with particular attention from the social participation forum COSAÚDE (Permanent Health Care Regulation Committee). There will be a scope meeting, for patients, experts, and representatives of medical societies and ANS. Soon after, we will develop studies on existing capacity, budget impact analysis, economic evaluation, and rapid systematic review. Between 2024 and 2026, we expect to update fifteen DUTs.
Conclusions: The updated DUTs will improve healthcare and better guide clinical recommendations for private health insurance beneficiaries in Brazil."
Objectives: Description of the DUT update procedure implementation and the expected results.
Methods and expected results: In addition to GRADE recommendations, the DUT updating method will observe the following actions. ANS will first identify and rank the themes that will be the focus of quick evidence mapping and feasibility analysis. This list of themes will be subject to public consultation, with particular attention from the social participation forum COSAÚDE (Permanent Health Care Regulation Committee). There will be a scope meeting, for patients, experts, and representatives of medical societies and ANS. Soon after, we will develop studies on existing capacity, budget impact analysis, economic evaluation, and rapid systematic review. Between 2024 and 2026, we expect to update fifteen DUTs.
Conclusions: The updated DUTs will improve healthcare and better guide clinical recommendations for private health insurance beneficiaries in Brazil."