Analysis of the economic and financial performance of health plan operators in Brazil (2007–2024)

Abstract

This study analyzes the economic and financial performance of Brazilian health plan operators from 2007 to 2024 and examines differences across years, periods, and organizational types. The research is quantitative, documentary, descriptive, and inferential and uses annual financial statements disclosed by the Brazilian National Agency for Supplementary Health (ANS). After data selection and treatment, the sample comprised 1,093 operators and 11,383 operator-year observations. Ten indicators of liquidity, indebtedness, profitability, return, and activity were calculated. The analysis included descriptive statistics, annual and organizational-type means, Welch’s ANOVA, and the Games–Howell post hoc test. The results reveal distinct profiles: self-managed operators combined higher liquidity and lower net debt; medical cooperatives showed higher returns; and philanthropic operators combined high EBITDA margins with negative return on equity, lower liquidity, and longer payment periods. Group medicine operators recorded the highest asset turnover without leading in net margin, while specialized health insurers showed the shortest collection period. Temporally, the improvement in profitability and returns in 2020 was followed by deterioration in 2021 and 2022 and partial recovery in 2023 and 2024. Significant differences across organizational
2
types, years, and periods show that favorable results in one dimension do not ensure equivalent performance in others. The study concludes that the economic and financial sustainability of health plan operators requires joint assessment of the indicators. It integrates five dimensions over a long historical series and offers evidence for managers, regulators, and other sector participants.