Diferenças de avaliação entre o Poder Judiciário e a ANS sobre a necessidade de oferecimento de home care nos contratos de plano de saúde

Detalhes bibliográficos
Autor(a) principal: Santos, Ezequiel Fajreldines dos
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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spelling 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
instname_str Fundação Getulio Vargas (FGV)
instacron_str FGV
institution FGV
reponame_str Repositório Institucional do FGV (FGV Repositório Digital)
collection Repositório Institucional do FGV (FGV Repositório Digital)
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repository.name.fl_str_mv Repositório Institucional do FGV (FGV Repositório Digital) - Fundação Getulio Vargas (FGV)
repository.mail.fl_str_mv
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