High expenditure on a private healthcare plan: for whom and in what

Abstract

OBJECTIVE: To assess expenditures and the profile of beneficiaries of a private health plan and the impact of these expenditures on the finances of both the plan and of beneficiaries. METHODS: Descriptive study including 64,219 costumers of a health insurance plan of the State of São Paulo in the year of 2003. The characteristics of high spenders were assessed according to age group, gender, type of expenditure, and related diseases. RESULTS: Among all customers, 642 beneficiaries (1%) were the highest spender in the year, accounting for 36% of the total. Among these beneficiaries, 45% were elderly, over 60 years old. Greatest expenditure was with medical supplies and drugs. Circulatory diseases, cancer, musculoskeletal diseases, respiratory tract diseases and the external causes were most frequently associated with these expenditures. CONCLUSIONS: Age is an important factor associated with high expenditures, being closely connected with chronic degenerative diseases. Thus, ageing of the population points out to the need for strategic changes in the management of private health care plans.