OBJECTIVES: This study aimed to analyze the evolution of health maintenance organizations (HMOs) in the period pre, during and post-economic crisis in different regions of Brazil.

METHODS: The number of lives and number of HMOs, stratified by 5 regions of Brazil (South, Southeast, Midwest, North and Northeast) and by modalities (Insurance, Medical Group, Medical Cooperative, and Self-management), were obtained from the National Agency of Supplementary Health website. The time horizon of the analysis was divided in pre-crisis (2012−2014), during (2015−2016), and post-crisis (2017).

RESULTS: In the pre-crisis period, there was an increase of 8.7% in the number of lives, with the higher growth in Midwest region. Regarding the type of HMO, there was a greater increase of insurers (21.4%). During the crisis, HMOs lost 5% of the number of lives, mainly in the North/Southeast regions. Medical group type HMOs did not have a loss of lives for the period (growth of 1.9%). In 2017, there was a recovery of beneficiaries (5%), with the exception of the Midwest region. Cooperatives and insurers were the fastest recovering types of HMOs, with 7.2% and 8.5% increase compared to 2015−2016, respectively. The number of HMOs with beneficiaries has been decreasing, with 962 in December 2012 to 766 in December 2017, but the coverage rate remained similar, being 22.1% and 22.7% in those periods.

CONCLUSIONS: The number of HMOs and HMO subscribers seems to be influenced by the economic situation in Brazil. Given the uncertainties about the economic, financial, and political situation in Brazil over the next few years, this is likely to influence the HMO sector. Expected trends include expansion of market consolidation with big mergers/acquisitions; expansion of private investment; and increased demand for popular individual plans. The impact of these trends on health care delivery and patient health care outcomes should be the subject of study.