The false private health insurance by association: a real case analysis of how actors influence the policy-making in health systems (is there any winner?)

Abstract

# Background After the edition of Law 9.656, 1998 many regulatory dilemmas have been brought to debate in Brazilian Supplementary Health, often triggered in a centrifugal way, from society to governmental organizations. # Methods This paper aims to investigate a Brazilian case study related to collective health plans by association consumers and specific contractual rescissions. Following an evidence-based policy question the author seeks to understand how the decision-making of normative process for the construction of a health system and its regulatory framework can be complex and intricate by several variants. This article uses the rational of different authors and perspectives as an initial parameter of analysis to uncover the extent to which stakeholders influence decision in policy-making regarding Health Systems and challenges of regulating a public-private structure. Using a concrete case study, the author constructs a rhetorical article allowing the reader to see herself/himself as part of the context of building a health system. The reader can immerge in the reality of the people and actors involved in the implementation of a country's regulatory process, permeated by diverse social interests. The public servant role and the debate of the difficult task of balancing the access to public and private service in a health system. Using an interpretivist inductive approach initiated by the debate of an evidence-based policy article, the idea is to demonstrate how power, culture and politics are factors, many times ephemeral but essential in the definition of science and the practical world of society and its systems. # Results The author uses a qualitative method of research analyzing the phenomenon of false collectives through this case study and a historical context of facts. No specific quantitative data were collected, and the case was analyzed according to author's knowledge of years of public service exercised in health regulatory field. This methodology seeks to draw a parallel between the interpretivist technique and the need to integrate social problems as well as the reader into the studied question. # Conclusions The epistemology of public service versus the society it serves and the role of each actor, as well as their dilemmas, traces the problematic investigated in this article. How the interpretivist technique can help unravel complex social problems and trace a philosophical route of learning and community participation to build a fairer and more balanced health system.