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Last book of the year coming through! The mismatch between corporate internationalization practices and the legislation suggests complacency by public authorities in the face of strategies that anticipated changes in the capitalization rules. Paulani LM. CRC Press. Suporte phpBB. The companies' records in the boards of trade are difficult to access, and the corporate reports are brief and generic, focused on publicity or exhibited as balance sheets, the interpretation of which requires expert knowledge. About the authors.

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Jul 28, Luiz H Registrado em: Abr 05, Deepening segmentation of the health care system in a context marked by the downturn in the national economy challenges the preservation of public subsidies for private health plans. In the middle of the first decade of this century, health insurance and health plan companies in Brazil began to acquire a clearly financial appearance, and the presence of their representatives in government decision-making spheres became frequent and visible.

The phenomenon is certainly not unique, and has links to the emergence of the post-Fordist regime, globalization of production, and widespread corporate reorganization in different national contexts 1 1. Arrighi G.

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Editora Vozes; The market concentration of companies in the health plan and health insurance industry is also not recent, having occurred in the s in the United States 2 2. The market structure of the health insurance industry. Washington DC: Congressional Research Service; CRS Report for Congress.

However, an analysis of specific results of the inclusion of private health insurance and health plan companies in Brazil's national health system is important for backing the discussion on tensions between the Brazilian Unified National Health System SUS and the private health plan industry. The relations between health plan companies and financial sectors accompanied the persistent inflation accompanying financial activities in the s, as in various areas of Brazil's economy 3 3.

Paulani LM. Estud Av ; Health plan companies contributed subsequently to the expansion of financial ventures. Private equity funds established by independent fund managers led by investment banks and pension funds 4 4.

Tempo Social ; Bahia L.

Rio de Janeiro: Editora Fiocruz; The literature on the origin and expansion of groups of health care professionals nearly always physicians shows different alternatives for marketing pre- and post-paid health care schemes, initially to employers and subsequently to individuals and families.

The initial studies highlighted changes in the corporate structure and relations with government agencies in the first companies 6 6. Giffoni MR. Cordeiro H.

Later studies focused on examining the companies that remained active or were created simultaneously with the debates and early implementation of the SUS 8 8.

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Modelo organizacional da Unimed: Although the literature highlights changes in the territorial scope and an increase in the number of policyholders 8 8. Considering the need to analyze the relations between the expansion of the private health plan industry and national health policy, the current study examines the history of health plan companies in Brazil through the classification of their supply and demand characteristics by recent historical periods and an analysis of recent shareholding changes in one of the industry's largest corporations.

The article thus centers on the systematization of shareholding structures and past political and institutional positioning and the analysis of a case that allows an approach to current accumulation strategies. The primary aim is to situate the current characteristics of health plan companies in relation to their historical background.

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The study's main limitations relate to the difficulties in adjusting conceptual frames of reference elaborated for grasping economic processes and global contexts to understanding unique events and the heterogeneity of corporate groups acting in the health plan market. Other limitations result from the difficulties in obtaining data on the companies' shareholding structure.

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The combination of these two limitations objectively hinders an understanding of the processes involved in the expansion of health care privatization. The initial effort at finding adequate frames of reference for examining changes in the accumulation regimes of health plan companies and the organization of an embryonic database does not allow answering the questions on the consequences for the SUS of the companies' affinity for financialization.

This article merely raises the question, for more in-depth investigation in future studies. The study was based on theoretical contributions from the collective health area and recent analyses on national and international processes of financialization and financial dominance, especially those focusing on the effects of financial dominance of social policies.

This is an exploratory study based on the literature and on systematization of data collected from government and corporate sources and in the commercial and academic media.

The study focuses primarily on the format of shareholding organization and processes of capital appreciation in health plan companies in two distinct political and economic circumstances: To depict the companies' characteristics in the two periods, considering supply, demand, and legislation, we drew on the concepts used by Donnangelo 11 Donnangelo MCF. Medicina e sociedade: Pioneira; To describe the rapid changes in the group's corporate profile, we drew on the concepts of financializaton and accumulation regime.

Financialization is a pattern of accumulation in which profits accrue mainly from financial channels, shaping an accumulation regime which, in the developed countries, results from the decline in profitability of productive activities, combined with credit expansion to protect consumption in the face of stagnation in real wage values 12 Boyer R.

Editora Nobel; Corporate practices for approaching the finance-dominated accumulation regime include a wide range of strategies, such as: Making sense of financialization. Socioecon Rev ; The analysis did not include the relevant focus of studies on financialization, corporate behavior, and discursive construction, expressed in intentional management strategies to celebrate what are announced as positive financial acquisitions 14 Shareholder value and financialization: Econ Soc ; Although there is a study on changes in the discourses and values of executives in the health insurance industry 15 Braga IF.

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The criteria for selecting the Amil health plan company included its size in the industry and its position as one of Brazil's largest corporations, as well its adoption of financialization strategies discussed in the literature. In , based on its asset value, Amil was classified as the largest health plan company in Brazil 16 Its corporate expansion involved launching shares on the Stock Exchange, acquisitions, and an overture to foreign investors.

To retrace Amil's history, we consulted company balance sheets and reports, Stock Exchange reports, specialized publications, scientific studies, and media stories.

Compilation of this material was painstaking but certainly not complete. The companies' records in the boards of trade are difficult to access, and the corporate reports are brief and generic, focused on publicity or exhibited as balance sheets, the interpretation of which requires expert knowledge.

Therefore, the search for and expression of the information obtained thereby attempted to balance the need to confer scope and precision to the results, referenced on possible spinoffs for the health system rather than an assessment of the company's economic performance per se.

The first is demarcated by relations between social security policies for the protection of skilled workers and the emergence of the first companies between the s and s. The second extended from the s to the s and was characterized by the marketing of company and individual health plans within the context of the implementation of the SUS.

The most recent period has involved the presence of companies with international capital and which perform activities in financial intermediation. Company health care policy agreements, established between the Social Security system and employers starting in , seen as a stratagem by employers to decrease worker absenteeism due to illness, stimulated the emergence of two types of health plan companies: The former were shaped predominantly as not-for-profit organizations.

Therefore, their legal status, although formally distinct, did not characterize them adequately. The main difference was the origin of the physicians workers' health services, usually public hospitals, and professional bodies and physicians' association with certified charitable hospitals.

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