Da inexistência de relação de consumo nas autogestões

Abstract

This article demonstrates the existing types of self-management institutions in healthcare, as well as that they are intended for closed groups, expressly defined in the norm of the National Supplementary Health Agency – ANS. In addition to observing eligibility criteria, the entities must ensure the representation of the beneficiaries and sponsors in the highest deliberative body, as they must participate in the governance of the institution. This fact is what differentiates a consumer or a contracting company from a member or a sponsoring or maintaining company of a self-management entity. As a result of these particularities, the Superior Court of Justice recognized the non-existence of a consumer relationship in healthcare self-management, through Summary No. 608. Despite some controversy since the advent of Law No. 14,454, of 2022, which amended Article 1 of Law No. 9,656 of 1998, in order to ensure the simultaneous application of the CDC, this article makes it clear that the foundations of the STJ summary remain in force, since the concept of consumer should be sought in the CDC and not in the health insurance law.