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Judicial claims for access to treatment in the private health insurance sector in Brazil

Author

Listed:
  • Wang, Daniel Wei Liang
  • Vasconcelos, Natalia Pires de
  • Santos, Ezequiel Fajreldines dos
  • Souza, Fernanda Mascarenhas de
  • Arantes, Luísa Bolaffi
  • Miziara, Nathalia Molleis
  • Oliveira, Bruno da Cunha de
  • Leite de Souza, Jacqueline
  • Malik, Ana Maria

Abstract

While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.

Suggested Citation

  • Wang, Daniel Wei Liang & Vasconcelos, Natalia Pires de & Santos, Ezequiel Fajreldines dos & Souza, Fernanda Mascarenhas de & Arantes, Luísa Bolaffi & Miziara, Nathalia Molleis & Oliveira, Bruno da Cun, 2026. "Judicial claims for access to treatment in the private health insurance sector in Brazil," Health Economics, Policy and Law, Cambridge University Press, vol. 21(1), pages 21-39, January.
    • Handle: RePEc:cup:hecopl:v:21:y:2026:i:1:p:21-39_3
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