By Aline Gonçalves Lourenço, Regulatory Law Specialist at Bhering Cabral Advogados (BHC)
In recent years, the National Supplementary Health Agency (ANS) has been promoting a significant transformation in its supervisory model. The traditional focus on the structure of customer service channels and formal adherence to regulations is gradually being replaced by an approach oriented towards performance and the beneficiary’s experience.
This new paradigm is crystallised in Regulatory Resolution No. 623/2024, which will enter into force in July 2025, and repositions the Notificação de Intermediação Preliminar (NIP – Preliminary Mediation Notice) as the central instrument in regulatory assessment. The rule redefines the function of the NIP by making it the primary input for two of the most important indicators: the General Complaints Index (Índice Geral de Reclamações – IGR) and the Monitoring of Service Guarantees (Monitoramento da Garantia de Atendimento – MGA). The IGR, previously a merely informative indicator, will henceforth generate concrete regulatory consequences, including financial and reputational impacts.
The new model sets explicit performance targets and institutes automatic mechanisms of incentives and penalties. Operators achieving excellence — for example, an IGR equal to or below 2.4 in medical-hospital plans — may benefit from up to an 80% reduction in fines. Conversely, failure to meet the targets may result in a 10% increase in penalties, irrespective of the initiation of an administrative sanctioning procedure.
It is important to note that this regulatory shift did not commence with RN 623/2024. RN 579/2023, by extinguishing the residual classification phase of the NIP, consolidated the link between a “not resolved” response and the opening of an administrative sanctioning procedure. With the approval of the new methodology at the 608th Meeting of the Collegiate Board of ANS, 50% of demands classified as “not resolved” came to be incorporated into the MGA calculation, even prior to any technical verification by the Directorate of Supervision (DIFIS).
The impacts of this new normative framework are already apparent. Public ANS data reveal that, in the fourth quarter of 2024, there was a 25% increase in the number of operators classified within the most critical ranges of the MGA compared with the previous quarter. This demonstrates that beneficiary perception is operating as a direct trigger for penalties, including for operators that, technically, would not otherwise present non-compliance.
Sectoral microdata simulations by ANS show that, in some operators, over 70% of NIPs classified as “not resolved” were subsequently deemed unfounded or without indication of breach after technical analysis. Moreover, consolidated data from the Service Guarantee Panel indicate that approximately 50% of “not resolved” NIPs are not confirmed as valid by DIFIS. These findings call into question the adequacy of the criteria employed.
From the consumers’ perspective, it is undeniable that incorporating indicators based on their experience — as occurs with the NIP methodology and in other care-monitoring initiatives — amplifies their voice in the regulatory process, promoting greater transparency, accountability, and alignment with the principles of responsive regulation. By granting the beneficiary a central role, the system signals that the value of supplementary health lies not only in operational efficiency, but also in the perception of quality and respect for user expectations.
Nevertheless, such openness cannot dispense with robust technical criteria and proper institutional mediation, lest it undermine the very regulatory legitimacy it seeks to reinforce. Providers and operators rightly warn of the risks posed by decisions anchored in isolated, subjective or unauditable perceptions, especially in a sector characterised by significant informational asymmetries and interpretative disputes over contractual obligations.
Accordingly, a responsive and efficient regulatory model must go beyond merely listening to the user: it must promote shared responsibility for information. This entails raising consumer awareness of the systemic impacts of their complaints, highlighting that each grievance is not merely an expression of dissatisfaction but a regulatory data point with practical effects — including in the definition of supervisory conduct, institutional reputation and the possible imposition of sanctions. Just as the regulator must escalate its responses proportionately, users should be called upon to understand the weight and consequences of their voice within the system.
Balancing the enhancement of the beneficiary’s experience with predictability, legal certainty, and technical fairness in evaluating operators is therefore one of the principal challenges of responsive regulation in the supplementary health sector. Achieving this balance requires not only sophisticated listening and analytical tools, but also regulatory education strategies capable of transforming the user from a passive participant into a conscious co-regulator committed to the equilibrium of the system.
To move in this direction, it is essential that the prominence granted to the beneficiary’s experience be accompanied by technical instruments that ensure balance, legitimacy and predictability in regulatory decisions. Active listening, while essential, cannot replace qualified technical analysis, particularly in a sector marked by high care and contractual complexity.
Some concrete measures may be proposed in this regard. First, the incorporation of complementary technical indicators alongside perceptual data — such as average response time, effective resolution rate, and recurrence index — would enable a more accurate and multifaceted assessment of operator performance. These indicators would function as analytical counterbalances, contributing to a fairer and more substantiated regulatory evaluation.
Secondly, the promotion of continuous training programmes in best practices for customer service and conflict resolution should be encouraged, with the support of ANS itself. Periodic workshops and technical events, bringing together operators, providers and beneficiary representatives, may strengthen a culture of cooperation and drive qualitative improvements in consumer interaction.
Another central aspect concerns transparency in the methodology for assessing Preliminary Mediation Notices (NIPs). Clear publication of classification criteria, together with the implementation of independent audit mechanisms and technical review, would enhance the confidence of regulated entities and provide stability to the regulatory framework. Predictability of regulatory consequences is a key element both for voluntary compliance and for the sustainability of the model.
There is little doubt that the movement promoted by ANS in recent years represents an important step towards regulation that is more responsive to beneficiary experience and results-oriented. The centrality accorded to user perception, the emphasis on resolution, and the use of performance indicators as compliance-inducing tools reveal a legitimate attempt to modernise state action in the sector.
Nonetheless, the criteria currently employed for measuring such performance still lack greater technical precision, methodological objectivity and normative stability. The centrality accorded to the NIP, if not accompanied by technical rigour and robust mechanisms for correcting distortions, may lead to systemic imbalances and excessively punitive regulatory responses — which run counter to the very foundations of responsive regulation.
Building a fair and sustainable regulatory model therefore requires balancing incentives for compliance, protection of beneficiaries, and operational rationality. This equilibrium cannot be achieved solely through intensified control, but rather through regulatory governance that values the quality of information, transparency in decision-making, and coherence between ends and means. Only in this way will it be possible to consolidate a truly technical, modern, and effectiveness-oriented agency.
References
- Agência Nacional de Saúde Suplementar (ANS). Painel de Dados Abertos. Available at: https://dadosabertos.ans.gov.br. Accessed: 19 May 2025.
- AYRES, Ian; BRAITHWAITE, John. Responsive Regulation: Transcending the Deregulation Debate. Oxford: Oxford University Press, 1992.
- ANS. Technical Note No. 3/2023/COESP/ASSNT-DIFIS/DIRAD-DIFIS/DIFIS. SEI Process No. 33910.038994/2023-28.
Originally published by Revista Brasileira de Saúde Suplementar (Instituto de Estudos de Saúde Suplementar)