Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional do FGV (FGV Repositório Digital) |
Texto Completo: | http://hdl.handle.net/10438/24160 |
Resumo: | This research explores judicial decisions about the home care services by health plan insurers and seeks to investigate if regulatory organs and the Judicial Power diverge about the obligatoriness of this service in heal plan contracts. For the analysis, was performed a research of the doctrine, all the decisions provided by the Agência Nacional de Saúde Suplementar (ANS) and by the Superior Tribunal de Justiça (STJ). The first chapter explains what are medical aid plans, their general characteristics and the regulation, creating an overview of the subject and the regulatory framework. The second chapter explores the ANS’ decisions, identifying the agency’s positioning e valuing its conformity to the regulatory framework. The third chapter covers decisions from STJ. In it, decisions and its justifications are analyzed. Finally, this works is concluded with the confrontation of the positions from ANS and from STJ. The conclusion is that the ANS and the STJ diverge about the necessity to offer the treatment: the ANS admits its exclusion, grounding its position in the possibility offered by the Health Plans’ Statue, while the STJ, invoking other normative precepts, determines that the home care must be offered. Beyond that, this research concludes that the divergence between regulators and the Judiciary Power may bring unwanted results to insured and insurers. |
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Santos, Ezequiel Fajreldines dosEscolas::DIREITO SPSundfeld, Carlos AriHirata, AlessandroPüschel, Flávia Portella2018-06-21T17:05:34Z2018-06-21T17:05:34Z2018-05-25http://hdl.handle.net/10438/24160This research explores judicial decisions about the home care services by health plan insurers and seeks to investigate if regulatory organs and the Judicial Power diverge about the obligatoriness of this service in heal plan contracts. For the analysis, was performed a research of the doctrine, all the decisions provided by the Agência Nacional de Saúde Suplementar (ANS) and by the Superior Tribunal de Justiça (STJ). The first chapter explains what are medical aid plans, their general characteristics and the regulation, creating an overview of the subject and the regulatory framework. The second chapter explores the ANS’ decisions, identifying the agency’s positioning e valuing its conformity to the regulatory framework. The third chapter covers decisions from STJ. In it, decisions and its justifications are analyzed. Finally, this works is concluded with the confrontation of the positions from ANS and from STJ. The conclusion is that the ANS and the STJ diverge about the necessity to offer the treatment: the ANS admits its exclusion, grounding its position in the possibility offered by the Health Plans’ Statue, while the STJ, invoking other normative precepts, determines that the home care must be offered. Beyond that, this research concludes that the divergence between regulators and the Judiciary Power may bring unwanted results to insured and insurers.Esta pesquisa explora decisões judicias sobre a prestação do serviço de home care por operadoras de planos de saúde e busca investigar se órgãos reguladores e o Poder Judiciário divergem sobre a obrigatoriedade desse serviço em contratos de planos de saúde. Para a análise, realizou-se levantamento da doutrina, de todas as decisões disponibilizadas pela Agência Nacional de Saúde Suplementar (ANS) e pelo Superior Tribunal de Justiça (STJ). O primeiro capítulo explica o que são planos de saúde, suas características gerais e a regulação, traçando um panorama do tema e do quadro regulatório. O segundo capítulo explora as decisões da ANS, identificando o posicionamento da agência e avaliando a conformidade dele com o quadro regulatório. O terceiro capítulo abarca as decisões do STJ. Nele, as decisões e fundamentos dos acórdãos são examinados. Finalmente, o trabalho é concluído com o confronto das posições da ANS e do STJ. A conclusão é que a ANS e o STJ divergem sobre a necessidade de oferecimento do tratamento: a ANS admite a sua exclusão, fundamentando sua posição na possibilidade oferecida pela Lei dos Planos de Saúde, ao passo que o STJ, invocando outros preceitos normativos, determina que o home care seja oferecido. Além disso, esta pesquisa conclui que a divergência entre reguladores e o Poder Judiciário pode trazer resultados indesejados para beneficiários e operadoras.porContratos de planos de saúdeAgência Nacional de Saúde SuplementarRegulaçãoSuperior Tribunal de JustiçaDireitoServiços de saúde - BrasilAssistência médica - RegulamentaçãoContratos - BrasilAgência Nacional de Saúde Suplementar (Brasil)Brasil. 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|
dc.title.por.fl_str_mv |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
title |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
spellingShingle |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde Santos, Ezequiel Fajreldines dos Contratos de planos de saúde Agência Nacional de Saúde Suplementar Regulação Superior Tribunal de Justiça Direito Serviços de saúde - Brasil Assistência médica - Regulamentação Contratos - Brasil Agência Nacional de Saúde Suplementar (Brasil) Brasil. Superior Tribunal de Justiça |
title_short |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
title_full |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
title_fullStr |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
title_full_unstemmed |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
title_sort |
Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde |
author |
Santos, Ezequiel Fajreldines dos |
author_facet |
Santos, Ezequiel Fajreldines dos |
author_role |
author |
dc.contributor.unidadefgv.por.fl_str_mv |
Escolas::DIREITO SP |
dc.contributor.member.none.fl_str_mv |
Sundfeld, Carlos Ari Hirata, Alessandro |
dc.contributor.author.fl_str_mv |
Santos, Ezequiel Fajreldines dos |
dc.contributor.advisor1.fl_str_mv |
Püschel, Flávia Portella |
contributor_str_mv |
Püschel, Flávia Portella |
dc.subject.por.fl_str_mv |
Contratos de planos de saúde Agência Nacional de Saúde Suplementar Regulação Superior Tribunal de Justiça |
topic |
Contratos de planos de saúde Agência Nacional de Saúde Suplementar Regulação Superior Tribunal de Justiça Direito Serviços de saúde - Brasil Assistência médica - Regulamentação Contratos - Brasil Agência Nacional de Saúde Suplementar (Brasil) Brasil. Superior Tribunal de Justiça |
dc.subject.area.por.fl_str_mv |
Direito |
dc.subject.bibliodata.por.fl_str_mv |
Serviços de saúde - Brasil Assistência médica - Regulamentação Contratos - Brasil Agência Nacional de Saúde Suplementar (Brasil) Brasil. Superior Tribunal de Justiça |
description |
This research explores judicial decisions about the home care services by health plan insurers and seeks to investigate if regulatory organs and the Judicial Power diverge about the obligatoriness of this service in heal plan contracts. For the analysis, was performed a research of the doctrine, all the decisions provided by the Agência Nacional de Saúde Suplementar (ANS) and by the Superior Tribunal de Justiça (STJ). The first chapter explains what are medical aid plans, their general characteristics and the regulation, creating an overview of the subject and the regulatory framework. The second chapter explores the ANS’ decisions, identifying the agency’s positioning e valuing its conformity to the regulatory framework. The third chapter covers decisions from STJ. In it, decisions and its justifications are analyzed. Finally, this works is concluded with the confrontation of the positions from ANS and from STJ. The conclusion is that the ANS and the STJ diverge about the necessity to offer the treatment: the ANS admits its exclusion, grounding its position in the possibility offered by the Health Plans’ Statue, while the STJ, invoking other normative precepts, determines that the home care must be offered. Beyond that, this research concludes that the divergence between regulators and the Judiciary Power may bring unwanted results to insured and insurers. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-06-21T17:05:34Z |
dc.date.available.fl_str_mv |
2018-06-21T17:05:34Z |
dc.date.issued.fl_str_mv |
2018-05-25 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10438/24160 |
url |
http://hdl.handle.net/10438/24160 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional do FGV (FGV Repositório Digital) instname:Fundação Getulio Vargas (FGV) instacron:FGV |
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FGV |
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FGV |
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Repositório Institucional do FGV (FGV Repositório Digital) |
bitstream.url.fl_str_mv |
https://repositorio.fgv.br/bitstreams/7b1d9f7c-c2a6-4480-8374-0ca12ebb5bb5/download https://repositorio.fgv.br/bitstreams/be48605d-b0c6-41f5-a7ae-2164a472cebb/download https://repositorio.fgv.br/bitstreams/b132d51d-35f4-48da-a2d8-444f8c040d0e/download https://repositorio.fgv.br/bitstreams/8992f55c-c71c-471f-b829-f65954a59090/download |
bitstream.checksum.fl_str_mv |
69290b8803a2537727f1693787310b81 b7abc374f1718e12c1363e0fc82f241b dfb340242cced38a6cca06c627998fa1 09fe44b1e06d38faff66e438d8ffff38 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional do FGV (FGV Repositório Digital) - Fundação Getulio Vargas (FGV) |
repository.mail.fl_str_mv |
|
_version_ |
1810023894634987520 |