Brazil hospital and health insurance data, with US benchmarks
This page brings together the key numbers of Brazil's hospital sector and private health insurance system, known as saúde suplementar: claim denials, days to payment, hospital margins, health plan results and cost trends. Each Brazilian figure comes with its period and primary source, and, where a comparable public figure exists, the US benchmark next to it.
Reviewed by the Accrua teamUpdated
Key numbers
Brazil vs. US at a glance
Brazilian hospitals see a large share of revenue disputed on first review but lose little of it in the end. The bigger issue is cash: Brazilian hospitals wait about 77 days to be paid by health plans.
| Topic | Brazil | United States | Comparability |
|---|---|---|---|
| Initial denials | Initial denials equal to 15.93% of amounts receivable from health plans, 2025 | No confirmed national figure in a primary source | Not comparable |
| Final denials | 1.72% of gross health plan revenue written off, 2025 | 2.7% median final denial rate, 2025 | Medium: both measure what is lost after appeals, with different denominators |
| Total revenue loss | R$ 1.8 billion in provisions for doubtful accounts and R$ 5.8 billion in withheld denials in 2024 (Anahp survey of 85 hospitals, Jan–Feb 2025) | US$ 48 billion lost to final denials and bad debt in 2025 across more than 2,300 hospitals, up 25% | Low: different scope |
| Bad debt | Not published at sector level | 1.3% median bad-debt rate, 2025 | — |
| Days to payment | 77.35 days from invoice to payment, 2025 | No public national median; Kodiak reported “true A/R days” up 5.2% in 2024 | Not comparable |
| Hospital margin | 11.05% average EBITDA margin (Anahp hospitals), 2025 | 1.7% median operating margin including allocations, YTD Mar 2026 | Low: EBITDA excludes depreciation and interest; operating margin does not |
| Private coverage | 52.9 million people in private health plans (about 25% of the population), Mar 2026 | 53.5% with employer coverage; 220 million with private insurance; 7.9% uninsured, 2025 | Medium |
| Insurer loss ratio | 81.5% average loss ratio (sinistralidade), 2025 | ACA requires at least 80% (individual and small group) or 85% (large group) | Brazil reports an actual average; the US figure is a legal floor |
| Insurer profitability | R$ 23.43 billion net income, 6.96% of premiums, 2025 (record) | — | — |
| Cost trend | VCMH Brasil 5.02% (2025); average employer plan increase 14.1% (12 months to Feb 2026) | PwC projects 8.5% medical cost trend for group plans in 2026 | Medium |
| Payment rules | Payment and dispute deadlines set in each written contract (ANS RN 503/2022) | Prompt pay laws vary by state | Regulatory, not numeric |
| National health spending | Not covered on this page | US$ 5.3 trillion, 18.0% of GDP, 2024 | — |
Why Brazil's initial denials are high but final losses are low: Brazilian hospitals bill mostly fee-for-service, item by item, and health plans audit and dispute individual items before paying. A large share is reversed after weeks or months of negotiation, so the final write-off is small but the cash is delayed. That is why days to payment, not final denials, is the most telling Brazilian indicator.
Claim denials in Brazilian hospitals
Hospitals associated with Anahp, Brazil's national association of private hospitals, had initial denials equal to 15.93% of amounts receivable from health plans in 2025. Final write-offs, the permanent loss after appeals and negotiation, were 1.72% of gross health plan revenue.
| Year | Initial denials | Final write-off, % of gross health plan revenue |
|---|---|---|
| 2022 | not measured | 0.78% (old basis: total net revenue) |
| 2023 | 11.89% | 1.17% |
| 2024 | 15.89% | 1.96% |
| 2025 | 15.93% | 1.72% |
First quarter of each year, final write-off: 0.92% (2023) · 1.87% (2024) · 1.66% (2025) · 1.61% (2026).
Methodology. Source: Anahp hospital indicators system (Observatório Anahp 2025; Balanço Observatório Anahp, March and June 2026). The sample is Anahp member hospitals, mostly large, high-complexity private hospitals: 169 members at the end of 2024 (119 reported data), 194 at the end of 2025 and 199 in 2026. Since 2023, the final write-off has been measured against gross health plan revenue (before, against total net revenue), so 2022 is not comparable. Method change in 2026: Anahp now divides initial denials by the amounts received from health plans in the month, not by the amounts receivable, so the 2026 series (11.69% in the second quarter, Balanço Observatório Anahp, 11th edition) is not comparable with 2023–2025.
Beyond denials: in an Anahp survey of 85 hospitals (January–February 2025), provisions for doubtful accounts totaled R$ 1.8 billion in 2024 (R$ 1.4 billion in 2023), and withheld denials, R$ 5.8 billion in 2024.
How this compares in the US. Kodiak Solutions, analyzing more than 2,300 US hospitals, reported a median final denial rate of 2.7% in 2025. Hospitals on its platform lost US$ 48 billion to final denials and bad debt, up 25%. The Brazilian figures are measured in value and the US figures largely in claims, so the levels are not directly comparable.
Days to payment
Brazilian hospitals in the Anahp sample waited an average of 77.35 days to be paid by health plans in 2025, up from 69.91 days in 2024, while paying their own suppliers in about 48 days.
| Year | Days to payment from health plans | Days to pay suppliers |
|---|---|---|
| 2021 | 68.56 | 43.27 |
| 2022 | 73.51 | 45.25 |
| 2023 | 76.38 | 49.40 |
| 2024 | 69.91 | 50.70 |
| 2025 | 77.35 | 48.30 |
First quarter of each year, days to payment: 75.80 (2023) · 72.32 (2024) · 74.31 (2025) · 73.84 (2026).
Methodology. Days between invoice issuance and payment, average of Anahp hospitals. The indicator does not capture the time before the invoice is issued. Annual and first-quarter figures are different series and should not be mixed. The 68.56-day figure often quoted for 2024 is actually the 2021 value.
How this compares in the US. There is no public national median for hospital days in accounts receivable. Kodiak reported that “true A/R days” rose 5.2% in 2024. In the US, payment deadlines for clean claims are set by state prompt pay laws; in Brazil, they are set in each hospital–health plan contract, as required by ANS Normative Resolution 503/2022.
Hospital finances
Anahp hospitals operate on thin margins: the average EBITDA margin fell to 11.05% in 2025 and 9.45% in the first quarter of 2026, with total expenses consuming about 93% of net revenue.
| Indicator | 2024 | 2025 | Q1 2026 |
|---|---|---|---|
| EBITDA margin | 11.68% | 11.05% | 9.45% |
| Total expenses / net revenue | 93% | 93% | 95.09% |
| Occupancy rate | 78.97% | 77.79% | 76.85% |
| Average length of stay | 3.99 days | 3.76 days | 3.72 days |
| Health plans' share of gross revenue | 78.80% | 76.47% | 80.21% |
In 2024, Anahp hospitals received 88.61% of what health plans owed them (85.80% in 2025, Observatório Anahp 2026), and open balances with health plans equaled 61.53% of average monthly billing.
How this compares in the US. Kaufman Hall's National Hospital Flash Report shows a median operating margin of 1.7% including allocations for 2026 year to date through March. EBITDA margins (Brazil) and operating margins (US) are different measures: EBITDA excludes depreciation and interest, so Brazilian figures are structurally higher.
Private health insurance market
Brazil had 52.9 million people in private medical health plans in March 2026, about one in four Brazilians, served by 667 health plan operators. The ten largest operators hold 43% of members and earned about 71% of the sector's net income in 2025.
| Indicator | 2023 | 2024 | 2025 | Q1 2026 |
|---|---|---|---|---|
| Members (millions) | 50.88 | 51.60 | 53.09 | 52.93 |
| Premiums (R$ billion) | 272.81 | 304.61 | 336.66 | 86.07 |
| Medical claims (R$ billion) | 236.56 | 253.37 | 272.13 | 63.68 |
| Loss ratio (sinistralidade) | 86.8% | 83.4% | 81.5% | 80.8% |
| Net income (R$ billion) | 1.93 | 10.29 | 23.43 | 6.02 |
| Net income / premiums | 0.71% | 3.38% | 6.96% | 7.00% |
| Bundled (package) payments, share of medical spending | — | 12.0% | 13.1% | 13.0% |
Methodology. ANS (Brazil's National Supplementary Health Agency) open data processed by Arquitetos da Saúde for the Balanço Observatório Anahp; excludes dental-only plans and benefit administrators. Figures may differ slightly from ANS releases.
How this compares in the US. In 2025, 53.5% of Americans had employer-based coverage, about 220 million had private insurance and 7.9% were uninsured (US Census Bureau). Brazil's 81.5% loss ratio is an actual market average; the US 80%/85% figures are the Affordable Care Act's minimum medical loss ratio, not an average.
Costs and price increases
Brazil's medical cost trend slowed to 5.02% in 2025 (VCMH Brasil, accounting data), but employer health plan increases still averaged 14.1% in the 12 months to February 2026. Individual plans had a 5.11% cap for May 2026 to April 2027, the lowest in the series apart from 2021.
| Indicator | 2023 | 2024 | 2025 | 2026 |
|---|---|---|---|---|
| Individual plan increase cap (ANS) | 9.6% | 6.9% | 6.1% | 5.1% |
| Average employer plan increase | 18.4% | 17.9% | 15.6% | 14.1% |
| VCMH Brasil (medical cost trend) | 11.66% | 6.67% | 5.02% | — |
| IPCA (consumer inflation) | 4.62% | 4.83% | 4.26% | — |
How this compares in the US. PwC projects a medical cost trend of 8.5% for group plans and 7.5% for individual plans in 2026. US national health expenditure reached US$ 5.3 trillion, 18.0% of GDP, in 2024 (CMS).
Revenue cycle benchmark from a private study
The Panorama do Ciclo de Receita 2026, published by ZG Soluções, analyzed data from the company's client institutions and found R$ 6.14 billion in denied amounts. In that base, the average initial denial rate was 8.86%, the final denial rate 6.58% and the average time to payment 53 days. The study attributes 67.9% of denied value to avoidable errors.
Methodology. Data from the company's client base, not a representative market sample; not directly comparable with Anahp's series.
Methodology
Brazilian data comes from Anahp reports and ANS open data, checked against the original documents. US data comes from the sources listed below, with each figure's period. Indicators are shown side by side for context, not as equivalent measures.
Frequently asked questions
What is the claim denial rate in Brazilian hospitals?
In 2025, Brazilian hospitals in the Anahp sample had initial denials equal to 15.93% of amounts receivable from health plans. Final write-offs, the permanent loss after appeals, were 1.72% of gross health plan revenue. In the US, Kodiak Solutions reported a 2.7% median final denial rate for 2025, measured differently.
How long do health plans take to pay hospitals in Brazil?
Anahp hospitals waited an average of 77.35 days from invoice to payment in 2025, up from 69.91 days in 2024. In the first quarter of 2026, the average was 73.84 days.
How many people have private health insurance in Brazil?
About 52.9 million people had private medical health plans in March 2026, roughly one in four Brazilians, according to ANS data processed in the Balanço Observatório Anahp. The rest of the population relies on SUS, Brazil's universal public health system.
Are Brazilian health plans profitable?
In 2025, Brazilian medical health plan operators posted record net income of R$ 23.43 billion, 6.96% of premiums, with an 81.5% loss ratio. The operating result was R$ 8.78 billion; the rest came mainly from financial income.
Sources
- Anahp — Observatório Anahp 2025 (dados de 2024)
- Anahp — Balanço Observatório Anahp, 9ª edição, março/2026 (dados de 2025)
- Anahp — Balanço Observatório Anahp, junho/2026
- ZG Soluções — Panorama do Ciclo de Receita 2026
- Anahp — Observatório Anahp 2026 (dados de 2025)
- Anahp — Balanço Observatório Anahp, 11ª edição (2º trimestre de 2026)
- Anahp — “Hospitais apelam por mudanças na relação com as operadoras” (25/03/2025; pesquisa com 85 hospitais)
- TechTarget — Kodiak Solutions, State of the Healthcare Revenue Cycle 2025 (mar/2026): denials, bad debt, US$ 48 bi
- Healthcare Finance News — Kodiak 2025
- Business Wire — Kodiak 2024 (true A/R days +5,2%)
- U.S. Census Bureau — Health Insurance in the United States: 2025 (tip sheet) e Becker's — dados do relatório
- Kaufman Hall — National Hospital Flash Report, March 2026
- CMS — National Health Expenditure fact sheet
- PwC — Medical Cost Trend: Behind the Numbers 2026
- CMS — Medical Loss Ratio