Primary Expenditure Drivers and Future Challenges From Emerging Technologies in Brazilian Private Market Real-World Data Analysis From a Brazilian Employer-Sponsored, Self-Insured Health Plan
Author(s)
Marcos Santos, MSc, PhD1, Goldete Priszkulnik, MSc, MD2, JULIANA BUSCH, MD3, Joao Paulo Dos Reis Neto, MD4.
1Profesor, Brasilia University, Sao Paulo, Brazil, 2ISPOR Brazil, SAO PAULO, Brazil, 3CAPESESP, Rio de Janeiro, Brazil, 4Diretor-Presidente da Capesesp, Rio de Janeiro, Brazil.
1Profesor, Brasilia University, Sao Paulo, Brazil, 2ISPOR Brazil, SAO PAULO, Brazil, 3CAPESESP, Rio de Janeiro, Brazil, 4Diretor-Presidente da Capesesp, Rio de Janeiro, Brazil.
OBJECTIVES: Brazilian private health insurers are facing growing financial pressure due to rising healthcare costs and the increasing adoption of high-cost medical technologies. This study aimed to analyze healthcare resource utilization among 60,147 beneficiaries of a Brazilian employer-sponsored self-insured health plan in a real-world setting.
METHODS: Retrospective, observational study using claims data from January/2019 to December/2024. Costs were analyzed from the payer’s perspective, adjusted for annual exchange rates. Primary outcomes were total and per capita healthcare expenditures, stratified by category (inpatient vs. outpatient), cost components (medications, diagnostics, and physician fees), and medical specialty. Time-trend analyses were performed to assess changes in cost distribution and inflation. Descriptive statistics were used to summarize demographic characteristics and cost data.
RESULTS: Total healthcare expenditures reached USD 384.7 million. The average annual per capita cost rose from USD 1,423 in 2019 to USD 3,543 in 2024 (20.6% average annual inflation rate). Inpatient care accounted for 56.7% of total spending, comprising 21.1% of room and facility fees, 20.0% of materials, 17.3% of medications, 14.9% of implants and devices, 9.2% of physician fees, and 17.5% for other payments. Outpatient expenditures included diagnostics (31.7%), chemotherapy (28.3%), therapies (11.8%), visits (7.1%), emergency visits (1.5%), and others (19.6%). Oncology is increasing from 22.2% of total costs in 2019 to 31.4% in 2025, with 28.9% average annual inflation.
CONCLUSIONS: The substantial increase in healthcare costs stems from multiple systemic factors, including regulatory changes in the incorporation process of new technologies into the national list of mandatory coverage, the persistence of the fee-for-service reimbursement model, and a post-pandemic surge in medical demand. Cost inflation was most pronounced in high-complexity areas such as oncology. These findings highlight the need for implementing value-based reimbursement models and strengthening health technology assessment processes to ensure financial sustainability in Brazil’s private healthcare sector.
METHODS: Retrospective, observational study using claims data from January/2019 to December/2024. Costs were analyzed from the payer’s perspective, adjusted for annual exchange rates. Primary outcomes were total and per capita healthcare expenditures, stratified by category (inpatient vs. outpatient), cost components (medications, diagnostics, and physician fees), and medical specialty. Time-trend analyses were performed to assess changes in cost distribution and inflation. Descriptive statistics were used to summarize demographic characteristics and cost data.
RESULTS: Total healthcare expenditures reached USD 384.7 million. The average annual per capita cost rose from USD 1,423 in 2019 to USD 3,543 in 2024 (20.6% average annual inflation rate). Inpatient care accounted for 56.7% of total spending, comprising 21.1% of room and facility fees, 20.0% of materials, 17.3% of medications, 14.9% of implants and devices, 9.2% of physician fees, and 17.5% for other payments. Outpatient expenditures included diagnostics (31.7%), chemotherapy (28.3%), therapies (11.8%), visits (7.1%), emergency visits (1.5%), and others (19.6%). Oncology is increasing from 22.2% of total costs in 2019 to 31.4% in 2025, with 28.9% average annual inflation.
CONCLUSIONS: The substantial increase in healthcare costs stems from multiple systemic factors, including regulatory changes in the incorporation process of new technologies into the national list of mandatory coverage, the persistence of the fee-for-service reimbursement model, and a post-pandemic surge in medical demand. Cost inflation was most pronounced in high-complexity areas such as oncology. These findings highlight the need for implementing value-based reimbursement models and strengthening health technology assessment processes to ensure financial sustainability in Brazil’s private healthcare sector.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
RWD138
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas