巴西私立医保市场增速骤降至0.2%，中资企业员工福利成本承压

Luiz Feitoza, of Arquitetos da Saúde Divulgação Brazil’s private health insurance market has been expanding since the outbreak of the pandemic in 2020. Over that period, the industry added 1.7 million members and now serves 53 million beneficiaries nationwide. Growth, however, has been slowing and has now reached a plateau. In the first five months of the year, health insurers added just 91,400 beneficiaries, equivalent to growth of only 0.2% over the period. In the same period of previous years, expansion ranged from 1.4% to 2.8%. “We’ve been asking ourselves for some time how long the sector could keep growing because the numbers had been consistently surprising. But there has been a significant slowdown this year. It’s the weakest performance for the first five months since 2020,” said Luiz Feitoza, a partner at healthcare consultancy Arquitetos da Saúde, which conducted the survey. Oncoclínicas files for out-of-court restructuring of R$5.1bn debt New healthcare payment models see low adoption For comparison, the industry added 146,000 and 341,000 beneficiaries in the first five months of 2024 and 2025, respectively. Between January and May, Hapvida, the country’s largest health insurer, lost 82,000 members, mainly in the state of São Paulo. A significant share migrated to Amil, which has adopted an aggressive pricing strategy and added 113,500 beneficiaries during the period. Hapvida said it “continuously monitors the evolution of its beneficiary base and has been conducting a structured review of its product portfolio, commercial processes and customer relationships since the beginning of the year,” adding that it “remains committed to sustainable growth and high-quality healthcare services.” Amil CEO Renato Manso said in a statement that the company “has been working hard to win new customers while maintaining the satisfaction of existing clients. In addition to offering a broad range of products serving different economic segments, we deliver high-quality services to ensure consistent growth.” Bradesco Saúde posted the strongest performance in the sector, adding 187,000 members. SulAmérica gained 61,400 beneficiaries, and Porto added 59,800. The figures are based on data from Brazil’s National Regulatory Agency for Private Health Insurance and Plans (ANS) and reflect the net balance between new enrollments and cancellations. FenaSaúde, the Brazilian Federation of Health Insurance Plans, has two forecasts for the year. Its more conservative scenario points to growth of 0.94%, while the more optimistic projection estimates an increase of 1.88%. Although data are already available through May, the ANS may revise the beneficiary base, including retroactively, because some insurers submit information with delays. Even taking those adjustments into account, as well as Brazil’s continued growth in formal employment, the outlook for sustained expansion remains challenging. The industry’s growth in recent years has not been driven by companies offering health insurance as an employee benefit. That segment has remained stable, with most movement coming from policyholders switching insurers. Instead, expansion has been fueled by micro and small businesses. Even so, that segment also appears to be reaching saturation, as in most cases these are family members purchasing health insurance through a corporate tax ID because premiums are lower and individual plans remain scarce. Around 4.9 million people are enrolled in contracts covering up to five beneficiaries—a structure commonly referred to as a “false group plan.” Plans purchased by micro and small businesses are less expensive. In other words, industry growth has been concentrated among lower- and middle-income consumers. At the same time, healthcare costs continue to rise rapidly. One reason is that, since 2021, the ANS has systematically added new medical procedures to the list of mandatory coverage for all health plans. Previously, those updates occurred every two years. In 2025, health and dental insurance plans covered 2 billion medical procedures, costing R$307.5 billion, an increase of 11.1% from 2024. Feitoza said insurers have “reduced coverage to keep products affordable.” “But there has already been a lot of downgrading, and I don’t see much room for further cuts. Now they’re charging dependents, but they’ve already increased co-payments, shifted coverage to regional networks, and introduced plans without reimbursement,” he said. Another challenge is the renewed rise in healthcare litigation. The number of new lawsuits filed between January and May reached nearly 155,000, up 20% from the same period in 2025, according to Brazil’s National Council of Justice (CNJ). “There is an increasingly challenging litigation environment, contrary to the initial expectations of positive effects from the Federal Supreme Court’s restrictive ruling. Current trends suggest there will be no short-term relief in legal costs for major insurers, with the risk of further acceleration,” Citi analysts Leandro Bastos and Renan Prata said. In September 2025, the Federal Supreme Court (STF) ruled that health insurers must cover treatments outside the ANS’s mandatory coverage list provided they meet five technical criteria. Those requirements were expected to reduce litigation. However, in the first quarter, 59% of new lawsuits—representing claims totaling nearly R$3 billion—sought coverage for procedures outside the mandatory list. After posting combined losses of R$15.5 billion between 2021 and 2023, the sector has rebounded over the past two years. In 2025, insurers reported an operating profit of R$10.2 billion, more than double the level recorded in 2024. In the first quarter, revenue totaled R$86.7 billion and operating profit reached R$3.8 billion. Another factor supporting the industry has been the high turnover rate among health plans, which stands at around 30%. Each time customers switch insurers, new waiting periods for certain types of coverage are imposed. As a result, insurers collect premium revenue while initially facing lower claims costs. The hospital sector, which came under severe pressure during the health insurers’ crisis, says that trend has continued despite the improvement in insurers’ financial performance. According to the National Association of Private Hospitals (Anahp), hospitals reduced their share of healthcare spending and medical inflation during the quarter. “The recovery of health insurers is positive and necessary for the entire private healthcare chain. However, it is essential that this improvement also translates into the sustainability of hospitals,” said Antônio Britto, Anahp’s executive director. According to Gustavo Ribeiro, president of the Brazilian Association of Health Plans (Abramge), the sector’s performance reflects expectations that 2026 will be a weaker year, with elections, the FIFA World Cup and numerous public holidays, although it is still too early to conclude that it will be a bad year for the industry. Ribeiro said the “room for growth is limited” by a rigid regulatory framework. FenaSaúde said that with unemployment at historically low levels, the uncertainties typically associated with an election year, and interest rates still elevated, the outlook for the end of 2026 is for stability or modest growth compared with 2025.