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Previous issue date: 2014-11-17 === Enquanto essenciais ? condi??o humana, a sa?de e a vida s?o protegidas desde tempos
remotos, espraiando-se pelas diversas ?reas do conhecimento, sobretudo na seara do Direito,
dada a fun??o din?mica deste na regula??o das intera??es sociais. Na ordem p?tria, a sa?de
goza de import?ncia maior a partir da Constitui??o Federal de 1988, que, rompendo com o
autoritarismo ditatorial e inaugurando um Estado Social de Direito, ora focado na liberdade e
na dignidade humana, al?a a sa?de ? categoria de direito social, marcada, predominantemente,
por um vi?s prestacional e incumbido, primariamente, ao Estado, por meio das pol?ticas
p?blicas. Todavia, dada a limita??o do Poder P?blico ? reserva do poss?vel, emerge a
impossibilidade de universaliza??o do acesso ? sa?de p?blica, porquanto o elevado custo das
presta??es m?dicas incapacita tal destinat?rio de prover todas as necessidades m?dicosanit?rias
dos titulares do direito. Diante dessa inefici?ncia estatal, emerge o esfor?o do
Constituinte ao criar um regime h?brido de realiza??o da sa?de, que, marcado pela
possibilidade de explora??o da assist?ncia ? sa?de pela iniciativa privada, atribui ao particular
um papel fundamental na suplementa??o da sa?de prestada pelo ente p?blico, sobretudo por
meio dos contratos de planos de sa?de. Nesse ponto, contudo, v?-se que a presta??o da sa?de
pelo agente privado n?o ? ilimitada, envolvendo embates acerca de servi?os e procedimentos
que devem ser exclu?dos da cobertura contratual, para fins de equil?brio setorial, de onde se
extrai a imprescindibilidade de pondera??o entre quest?es jusfundamentais de um lado,
atinentes ? prote??o da sa?de e da vida, e preceitos contratuais de outro, relativos ? primazia
da autonomia privada. Emerge da?, pois, a import?ncia da regula??o empreendida pela ANS, a
qual, por meio das amplas fun??es, da consider?vel autonomia e da discricionariedade t?cnica
apreendidas, encontra-se em condi??es de realizar um controle efetivo rumo ? harmoniza??o
do tri?ngulo regulat?rio, ? estabilidade e ao desenvolvimento do segmento de sa?de
suplementar e, consequentemente, ? universaliza??o do acesso ? sa?de, nos termos
constitucionalmente propostos. ? luz disso, desenvolve-se o presente trabalho, que, partindo
de um amplo estudo legislativo, doutrin?rio e jurisprudencial, conclui que a regula??o
econ?mica sobre o setor da sa?de suplementar, quando legitimamente exercida, proporciona o
progresso e o equil?brio setoriais e, inclusive, viabiliza a universaliza??o do acesso ? sa?de,
n?o podendo ser substitu?da, de modo eficiente, por qualquer outra fun??o estatal. === While essential to human nature, health and life have been protected since ancient times by
various areas of knowledge, particularly by the Law, given its dynamics within the regulation
of social interactions. In Brazil, health has been granted major importance by the Federal
Constitution of 1988, which, disrupting the dictatorial authoritarianism, inaugurating a Social
State and focusing on the values of freedom and human dignity, raises health to the condition
of a social right, marked predominantly by an obligational bias directed, primarily, to the
State, through the enforcement of public policies. Although, given the limitation of the State
action to the reserve for contingencies, it turns clear that an universalizing access to public
health is impossible, seen that the high cost of medical provisions hinders the State to meet all
the health needs of the rightholders. As a result of the inefficiency of the State, the effort of
the Constituent Assembly of 1988 in creating a hybrid health system becomes nuclear, which,
marked by the possibility of exploration of healthcare by the private initiative, assigns to the
private enterprise a key role in supplementing the public health system, especially through the
offer of health insurance plans. At this point, however, it becomes clear that health provisions
rendered by the private agents are not unlimited, which involves discussions about services
and procedures that should be excluded from the contractual coverage, for purposes of
sectoral balance, situation which draws the indispensability of deliberations between
Fundamental Rights on one hand, related to the protection of health and life, and contractual
principles on the other hand, connected to the primacy of private autonomy. At this point, the
importance of the regulation undertaken by the ANS, Brazilian National Health Agency,
appears primordial, which, by means of its seized broad functions, considerable autonomy and
technical discretion, has conditions to implement an effective control towards the
harmonization of the regulatory triangle, the stability and development of the supplementary
health system and, consequently, towards the universalization of the right to health, within
constitutional contours. According to this, the present essay, resorting to a broad legislative,
doctrinal and jurisprudential study, concludes that economic regulation over the private
healthcare sector, when legitimately undertaken, provides progress and stability to the
intervening segment and, besides, turns healthcare universalization feasible, in a way that it
can not be replaced efficiently by any other State function.
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