Employers in Brazil face a range of challenges as they struggle to address medical inflation. Companies shared their efforts with medical plan offerings, well-being initiatives and non-health benefits. Topics included employee cost-sharing efforts, claims data audits and analytics, right-to-health litigation injunctions, primary and maternity care, occupational health regulations and well-being integration, employee assistance program (EAP) and mental health offerings, well-being efforts to control health care costs, and retirement benefits.
Twenty-four attendees from 13 companies participated in the call. Companies came from various industries, including telecommunications, consumer products/apparel/household, banking/financial services, manufacturing, professional services and technology.
The Global Institute of Business Group on Health hosted a 60-minute member conversation about health and benefits in Brazil. Call content was driven by attendees based on standard market practice in medical and health benefits offerings and other health promotion priorities in Brazil.
Health Care Costs
In 2019, Brazil had double-digit health care cost increases, which is four times higher than general inflation (CPI) and salary increases (see Fig. 1).1,2 Employers are looking at different ways to control health care costs through cost-sharing strategies, claims audits and health promotion efforts.
Employers use various cost-sharing mechanisms to control costs and utilization. In terms of employee cost-sharing strategies, most employers on the call have copays or a reimbursement model (Fig. 2). The percent of copays varies from 10% to 30%. For reimbursement mechanics, employers use percent of employees’ gross salary per month. One company has a deductible for hospitalization. The companies are hoping to see changes in behavior, but there is high utilization.
Fig. 2: Employers’ Approaches to Cost-Sharing Strategies (n=10)
Sixteen percent of respondent employers are self-insured in Brazil.3 Those companies have greater access to claims data analytics and auditing efforts. Some self-insured employers have doctor panels and third-party administrator (TPA) reviewing medical bills and utilization to find ways to manage costs. A fully insured company uses its broker to review claims and manage costs. TPA oversees disease management and pregnancy programs. One major challenge is that self-insured employers are trying to get a handle on right-to-health litigation injunctions where employees sue for access to certain services. Companies are trying to balance meeting employees’ needs, evidence-based care and escalating health care costs.
Maternity claims in Brazil are often a high utilization driver, with the frequency of certain tests and exams not always evidence- based. One company developed a maternity program where employees who follow a specific schedule of visits, exams and tests receive a more generous benefit. The program doesn’t include any preferences for vaginal childbirth versus Caesarean sections. The program’s schedule removes services that lack evidence and reduce cost. Another company has a similar program through a vendor. Employees who participate in the program have their copayments waived. The company also provides a new baby kit to employee families when the child is born.
One area of common struggle is that employees not accessing primary care. Some companies are planning to use their on-site clinics to address this need. One company is monitoring emergency room care utilization and trying to promote primary care.
|Rank||Ages 15-49||Ages 50-69|
|1||Headache disorders||Interpersonal violence||Ischemic heart disease||Ischemic heart disease|
|2||Low back pain||Road injuries||Stroke||Stroke|
|3||Anxiety disorders||Low back pain||Diabetes||Diabetes|
|4||Depressive disorders||Alcohol use disorders||Low back pain||Cirrhosis|
|5||Dietary iron deficiency||Headache disorders||COPD||Low back pain|
|6||Road injuries||Ischemic heart disease||Breast cancer||COPD|
|7||Other musculoskeletal disorders||Self-harm||Headache disorders||Lower respiratory infections|
||Interpersonal violence||HIV/AIDS||Depressive disorders||Road injuries|
|9||Gynecological diseases||Drug use disorders||Lower respiratory infections||Lung cancer|
||Cirrhosis||Chronic kidney disease||Chronic kidney disease|
Companies have occupational health staff to meet stringent regulations. Companies would like to engage their occupational health staff in their well-being efforts. The main challenge is their lack of bandwidth to add well-being to their existing responsibilities given all the occupational health regulations and procedures they must follow. One company’s occupational health doctor is part-time. One company has integrated well-being aspects (e.g., sleep, musculoskeletal) in required occupational health assessments by tying occupational health and well-being together. Companies are also trying to integrate emotional/mental well-being as well.
To tackle high health costs and utilization, companies are focusing on health promotion efforts in Brazil. Several companies are using claims analysis data to help create health programming for their employee population needs. One company implemented a global well-being platform (through a vendor) that addresses financial, mental and physical health. The company hopes to engage employees in their holistic well-being and preventive care to reduce health care costs. Another company has a health committee that meets bimonthly to address health and well-being issues and programming.
Well-being efforts that employers offer in Brazil:
- Discounts on well-being related equipment and services;
- Financial education;
- Healthy food access (via food carts);
- On-site psychologist;
- Physical activity challenges;
- Preventive health services;
- Well-being platform; and
Employers have different approaches to addressing mental health. One company negotiated unlimited mental health support (specifically psychiatrist visits) with their health plan provider. Another company has an on-site psychologist who is available through an online registration system and meeting space is secluded from the main workspace for privacy. The company also has a 15% EAP utilization rate, which is similar to other large locations in the Latin America region. This rate was achieved through communication efforts. A third company incorporates anxiety and depression screening tools into required medical exams. Screening tools are in line with U.S. Preventive Services Task Force recommendations.
Companies are reviewing their pension plans as the Brazilian government makes changes to retirement regulations. Brazil has increased the retirement age to 65 for men and 62 for women, as people are living longer. Companies are looking at ways to engage employees in their retirement benefits:
- Providing flexibility and what that means for employer contributions; and
- Considering whether an employer match is competitive.
Relevant Business Group Resources
- Innovative Benefits in Latin America Survey Report
- Leave and Family-Friendly Benefits: Americas
- Understanding Health: Americas Perspective
- Tobacco in the Americas Region
- Women in the Workforce: Americas
- Global Numbers You Need:
More TopicsArticles & Guides Americas
- 1 | Aon. 2020 Global medical trend rates report. 2019. https://healthresources.aon.com/reports-2/2020-global-medical-trend-rates-report. Accessed September 19, 2019.
- 2 | Korn Ferry. Global salary forecast 2019: Smaller real-wage increases predicted for most parts of the world. 2019. https://engage.kornferry.com/Global/FileLib/Pay/KF_2019_Salary_Forecast_Main_Infographic_Aw.pdf. Accessed October 31, 2019.
- 3 | McManus T. Brazil benefits and well-being benchmarking survey results. Business Group on Health. 2017. https://www.businessgrouphealth.org/resources/survey-results-benefits-and-well-being-benchmarking-brazil. Published November 2017. Accessed February 3, 2020.
- 4 | Institute for Health Metrics and Evaluation. Global burden of disease (GBD) compare. 2018. https://vizhub.healthdata.org/gbd-compare/. Accessed January 20, 2020.