Established through a specific sector at the Ministry of Health, the ANS must comply with Law Nº 9,656 promulgated in June 1998. This Regulator was established through Law Nº 9,961 dated January 28, 2000, as the regulator of an economic sector with no operating standards. The exception was healthcare insurance and insurers, which are under the economic and financial control of the Private Insurance Industry Regulator (SUSEP).
Supplementary healthcare functions alongside the government system, consolidated through Brazil’s Unified National Health System (SUS), which is rooted in its 1988 Constitution. Health was established by law as a citizen’s right, assigned the status of a public asset.
Health plans date back to the establishment of the Santas Casas de Misericórdia, which were institutions linked to the Roman Catholic Church, engaged mainly in charitable and philanthropic activities. Initially, they accepted patients with many different types of illnesses, except for infectious and contagious diseases.
These Santas Casas were the main providers of hospital services in Brazil from Colonial times onwards, continuing through the Brazilian Empire and the Old Republic and encompassing the Estado Novo regime during the first half of the XX century.
Opportunities for the economically valid supply of healthcare facilities began to appear during the 1930s in Brazil, followed by a growth spurt during the late 1950s, when Brazil moved into a major industrialization cycle, as factories were set up in the ABC industrial region around São Paulo. At that time, private hospitals firmed up their position as the main providers of these services to the emerging middle class.
Still during the XX century, the Brazilian health system followed in the footsteps of other Latin American countries (Mexico, Chile, Argentina and Uruguay), developing through pension funds and social security. This is when the Retirement and Pension Savings and Loan Associations known as CAPs (Caixas de Aposentadorias e Pensões) appeared, initially for railroad workers. They were followed by the Retirement and Pensions Institute (IAPs), unified into the National Social Security Institute (INPS) that later gave rise to the National Social Security Medical Aid Institute (INAMPS) in 1974.
Today, the Brazilian health plans and insurance sector ranks as the world’s second largest private healthcare system.