From Sanitary Hegemony to Liberal Dominance: Investigating the Factors that Prevented a Liberal Inflection at the National Health Agency - ANS (2004-2014)

Abstract

From Sanitary Hegemony to Liberal Dominance: Investigating the Factors that Prevented a Liberal Inflection at the National Health Agency-ANS (2004-2014) This paper analyzes the policy on supplementary health regulation conducted by the National Health Insurance Agency – ANS, in the Portuguese acronym. We investigated how power disputes between sanitarians and liberals were transposed to the agency through political appointments to management positions and how this influenced the institution’s regulation between 2000 and 2014. To characterize the political groups in the different administrations, we built networks of connections between politicians and ANS directors, examined the role of health insurance companies in supporting ANS leaders, as well as the profile of directors. To identify regulatory outcomes, we analyzed key decisions made and the voting pattern of directors. The research, based on mixed methods, used document analysis and interviews with 45 key actors in the sector, which were the basis for network analysis. The study revealed that after a period of sanitary domination, the most liberal groups in the ANS became the majority. However, these changes in the board did not result in pro-market regulations. This is explained by the political game, as well as by institutional and sectoral factors such as the lack of consensus in the market, the sanitary bureaucracy of the ANS, which acted as a brake on liberalizing measures, and the regulatory framework, which limits the power of the ANS regarding pro-market actions.