Reflexo do aumento de diagnósticos do Transtorno do Espectro Autista (TEA) sobre os reajustes dos planos de saúde

Abstract

Autism Spectrum Disorder (ASD), a neurodevelopmental disorder and condition that requires ongoing multidisciplinary therapies—such as speech therapy, psychology, occupational therapy, and physical therapy—has shown a significant increase in global prevalence. Based on this growth, this study analyzed how the rising use of ASD-related procedures impacted adjustment percentages in collective health insurance plans between 2015 and 2023 among beneficiaries aged 0 to 19. To do so, we employed descriptive and explanatory analysis, quantitative methods, document analysis, and segmented multiple linear regression by health insurance provider size (small, medium, and large). Among the findings, we identified that smaller providers were more sensitive to increased demand for procedures, with adjustments influenced by the use of physical therapy and psychology services by beneficiaries aged 0 to 19. Although they have greater financial flexibility, large providers account for about 75% of the procedures used and are particularly affected by demand from the 1 to 9 age group. While the quantitative impact of the analyzed variables on adjustment percentages was small, the results highlight disparities among providers of different sizes and indicate the need for differentiated mechanisms to ensure financial sustainability without compromising access to continuous treatments.