FATORES DETERMINANTES DA ESCOLHA ENTRE PLANOS DE SAÚDE E PLANOS ASSISTENCIAIS: um estudo sobre tomada de decisão em saúde suplementar

Abstract

This study addresses the supplemental health landscape in Brazil, focusing on the duality between health insurance plans regulated by the National Health Agency (ANS) and health assistance plans (discount cards). The general objective was to identify the determining factors in the decision-making process of beneficiaries between these modalities in Naviraí-MS. The methodology was characterized as exploratory and quantitative research, with data collection conducted via structured questionnaires.

The results indicate the preponderance of the economic factor, with low monthly fees being the main attraction of assistance plans for 46.7% of users. It was found that the perceived deficiency in the Unified Health System (SUS), especially the delay in specialized consultations, drives the search for the private sector in both groups. While the assistance plan is sought for outpatient agility, the health insurance plan is selected for security in high-complexity procedures and hospitalizations, a factor mostly made viable through corporate benefits (60.7%). The study concludes that assistance plans occupy a market gap for the low-income population, highlighting the need for further discussion on the legal protection of these users and the creation of business models that balance accessibility and healthcare security.