Precificação atuarial em operadoras de planos de saúde no Brasil : um estudo de caso

Abstract

The supplementary health sector in Brazil has shown a great growth in the last years since the regulation by the National Supplementary Health Agency (ANS), which, until the 3rd quarter of 2018 accounted for R $ 142 billion in revenues and R $ 120 billion. in healthcare expenses. In this scenario, it is vital that health insurance operators maintain their financial balance, and proper actuarial pricing is of paramount importance. The present research consisted of the application of an actuarial pricing technique to obtain the commercial premiums of the beneficiaries of a health plan operator in Brazil. It was decided to use the individual risk model in which it was necessary to constitute empirical probability distributions for each age group, based on these distributions, Monte Carlo simulation was applied to generate random values ​​of care costs for each beneficiary used in the research. where it was found that younger beneficiaries are more likely to consume fewer operator resources than older staff. Although the age group of 59 years or older presented a dispersion of costs similar to the younger ones due to the massification of risk in this range. This study was relevant to the public and the actuarial community, contributing to a better understanding of the actuarial pricing process, so that the knowledge generated improves the management of health insurance operators, guiding them to a sustainable and safe market position.