How Long Do Beneficiaries Stay? A Real-World Data Study of Enrollment Time Across HMOs in Brazil’s Private Health System
Author(s)
Beny Finkelstein, MBA1, Douglas G. Silva, Master degree in Health Economics2, Marcelo Zlotnik, BSc1.
1Autonomous, São Paulo, Brazil, 2Health Economics, DS Consulting, São Paulo, Brazil.
1Autonomous, São Paulo, Brazil, 2Health Economics, DS Consulting, São Paulo, Brazil.
OBJECTIVES: To present the first structured, nationwide analysis of beneficiary retention times in Brazil’s private health sector, leveraging an unprecedented cleaned and consolidated dataset to examine actual retention patterns across HMO's, states, modalities, and plan types.
METHODS: Data were extracted from publicly available datasets published by Brazil’s National Regulatory Agency for Private Health Insurance (ANS), in Oct/2024. Beneficiary-level data by HMO were consolidated enabling to calculated the average time beneficiaries remained enrolled within each health plan, considering active and inactive statuses to reflect total historical permanence. Aggregations were conducted by HMO, state (UF), provider modality, and contract type. Plans with hybrid or ambiguous contract classifications were excluded from cross-segment analyses.
RESULTS: A total of 745 active HMO's were identified, each corresponding to a distinct registered provider with at least one active health plan record. The average enrollment time across all records was 6.4 years (median: 4.0; SD: 6.6), but when weighted by the number of active beneficiaries, the national average decreased to 4.7 years. Individual and self-managed plans showed the highest retention times, exceeding 14 years on average. In contrast, collective employer-sponsored plans presented the shortest average duration, at approximately 6.2 years. The top five HMO's concentrated over 15 million active beneficiaries, with weighted retention times ranging from 6.3 to 7.5 years.
CONCLUSIONS: This study provides the first publicly available benchmark of enrollment duration in Brazil’s private health system. Contrary to the commonly cited assumption of a three-year average, actual retention times are significantly longer for most plan types and modalities. These findings offer a critical foundation for designing long-term access strategies, risk-sharing agreements, and economic evaluations tailored to the dynamics of the market. Improved data transparency and continued monitoring may help refine assumptions used in health policy and long-term value-based contracts.
METHODS: Data were extracted from publicly available datasets published by Brazil’s National Regulatory Agency for Private Health Insurance (ANS), in Oct/2024. Beneficiary-level data by HMO were consolidated enabling to calculated the average time beneficiaries remained enrolled within each health plan, considering active and inactive statuses to reflect total historical permanence. Aggregations were conducted by HMO, state (UF), provider modality, and contract type. Plans with hybrid or ambiguous contract classifications were excluded from cross-segment analyses.
RESULTS: A total of 745 active HMO's were identified, each corresponding to a distinct registered provider with at least one active health plan record. The average enrollment time across all records was 6.4 years (median: 4.0; SD: 6.6), but when weighted by the number of active beneficiaries, the national average decreased to 4.7 years. Individual and self-managed plans showed the highest retention times, exceeding 14 years on average. In contrast, collective employer-sponsored plans presented the shortest average duration, at approximately 6.2 years. The top five HMO's concentrated over 15 million active beneficiaries, with weighted retention times ranging from 6.3 to 7.5 years.
CONCLUSIONS: This study provides the first publicly available benchmark of enrollment duration in Brazil’s private health system. Contrary to the commonly cited assumption of a three-year average, actual retention times are significantly longer for most plan types and modalities. These findings offer a critical foundation for designing long-term access strategies, risk-sharing agreements, and economic evaluations tailored to the dynamics of the market. Improved data transparency and continued monitoring may help refine assumptions used in health policy and long-term value-based contracts.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR115
Topic
Health Policy & Regulatory, Real World Data & Information Systems, Study Approaches
Topic Subcategory
Insurance Systems & National Health Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas