Payer financial results: what ANS data tells hospitals

What are payer financial results?

Payer financial results are the economic and financial figures that Brazilian health plans (operadoras) report to the National Supplementary Health Agency (Agência Nacional de Saúde Suplementar, ANS), Brazil's regulator of private health plans. The agency consolidates and publishes them every quarter. The source is the DIOPS (Documento de Informações Periódicas das Operadoras, the periodic financial filing), sent monthly or quarterly depending on the plan [2].

ANS publishes the data in the Painel Econômico-Financeiro da Saúde Suplementar (Supplementary Health Economic-Financial Dashboard), which can be queried by quarter since 2018, and in a release at each update [1]. Each plan's accounting data are also available on the ANS open data portal [4].

For a hospital, the logic is the one explained in the pillar guide Brazilian private healthcare: a large share of a health plan's medical expenses is the network's revenue. Reading sector results helps a hospital understand the negotiating climate, but it does not replace the hospital's own indicators.

The latest ANS figures (first half of 2026)

As of October 17, 2026, the latest ANS release covers the first half of 2026 and was published on September 16 [1]. Third-quarter data had not yet been released.

Source: ANS, release of September 16, 2026 [1].

ANS attributed part of the loss ratio increase to two one-off factors: a voluntary technical reserve booked by one of the largest health plans and a capital injection by the sponsor of a self-insured employer plan (autogestão) [1]. Even so, it was the second-lowest level since 2020 [1].

Before the full release, ANS presented a preview in August covering 214 mid-size and large health plans (30.7% of the 697 required to file the second-quarter DIOPS), with 43.9 million members [5]. In that sample, net income was BRL 8.5 billion and the loss ratio accumulated through June was 82.2% [5]. The preview does not represent the whole market and should not be compared directly with the final release.

Operating result is not the same as profit

The operating result shows what a health plan earns from the health plan business itself; net income also includes what it earns from financial investments and assets. ANS defines the three measures this way [1]:

In the first half of 2026, medical-hospital plans had net income of BRL 10.9 billion and an operating result of BRL 5.6 billion [1]. In other words, almost half of the profit came from outside the plan business, at a time when these plans held BRL 142.4 billion in financial investments [1].

This matters at the negotiating table. A plan with high profit and a thin operating result depends on financial returns, which move with interest rates. A plan with a positive, steady operating result has more room in its own operation. On their own, the figures do not say how a given plan will handle rate increases, denial (claim denial) or payment timing.

How should you read the loss ratio in the results?

The loss ratio (sinistralidade) is the share of medical premium revenue used to pay medical expenses [1]. It is the line most tied to the network: physician visits, tests, therapies and hospital stays paid to providers are all part of those expenses. It is close to the US medical loss ratio (MLR), but Brazil has no MLR floor or rebate rule.

Three precautions prevent misreadings:

• Period. ANS publishes cumulative figures (quarter, half, nine months, year). Always compare with the same period a year earlier, as the release itself does [1].
• One-off factors. Extraordinary reserves and capital injections move the indicator. In 2026, ANS pointed to both [1].
• Source. The ANS figure may differ from series that treat the same data with another scope or other adjustments. The Health plan loss ratio guide shows the long series and compares the two.

For hospitals, a rising loss ratio tends to come with cost-containment talk. However, RN 503/2022 (Resolução Normativa 503, ANS's rule on payer-provider contracts) bans contract terms that tie the provider's rate increase to the health plan's loss ratio (art. 5, VII) [6]. The indicator can come up in the conversation, not in the clause.

Administrative expenses: the line few people check

Administrative and selling expenses are what a health plan spends to run itself and sell plans, apart from care. Under the ANS definition, they reduce the operating result together with medical expenses [1].

The September 16, 2026, release does not give the amount of these expenses [1]. To find it, use the Economic-Financial Dashboard or each plan's financial statements on the ANS open data portal [4].

When reading plan by plan, two ratios over premium revenue are worth watching: the loss ratio and the administrative expense ratio. Together, they show what is left for selling costs, taxes and margin. A plan that cuts medical spending while administrative costs grow tells a different story from one that reduces both.

What do ANS figures not show about payment timing?

ANS economic and financial data do not report how many days each health plan takes to pay the network. Payment terms are set in the hospital-payer contract, and tracking them is up to the hospital.

The hospital side shows up in other sources. At hospitals that belong to Anahp (Associação Nacional de Hospitais Privados, Brazil's association of leading private hospitals), the average collection period was 77.35 days in 2025 and 73.84 days in the first quarter of 2026 [3]. In the same group, the EBITDA margin was 11.05% in 2025 and 9.45% in the first quarter of 2026 [3].

These numbers do not prove any causal link with payer results. They only show that high sector profit and faster payment to the network did not go together in the period. ANS keeps its own indicator that helps here: its claim denial dashboard (Painel de indicadores de glosa) measures, by health plan, the share of claims with no response at all (paid or denied) 30 days after submission [7].

To measure and pursue late payments, see the guides Hospital days to payment and Late payer payments.

How hospitals use these figures, line by line

For a hospital, payer financial results serve as negotiating context and as a monitoring signal, not as a forecast of how a specific plan will behave.

In negotiations, sector figures work best as background. The core argument is still the hospital's cost, quality and the history of each contract, as the Payer rate negotiation guide explains.

What we see in operations

At Accrua, ANS figures serve as context, not as an explanation of what happens on a given claim. They show the sector's results and loss ratio, but they do not show payment time to providers or the reason for each denial. That data exists only in each hospital's own history.

So when we read a hospital's history, we track payment time, denial rate and appeals upheld by health plan, plan and claim type, quarter by quarter. Putting that series next to the health plan's financial statements helps the hospital prepare for negotiation, without assigning a cause where there is no evidence.

That risk reading by health plan is also the basis of Receita Garantida: Accrua puts the value of eligible production into the hospital's account when it needs it and takes on the risk of eligible denials, with no need for the hospital to pay the money back later.

Where to start

1. Mark the calendar for the quarterly ANS releases and read each one on the day it comes out.
2. List your five largest health plans by hospital billing and download each one's financial statements from ANS open data. The ranking and payment profile of the country's largest are in the guide Brazil's largest health plan operators.
3. Calculate three ratios per plan: loss ratio, administrative expenses over revenue, and operating result over revenue.
4. Put your own indicators next to them: collection period, denial rate and rate increase obtained, by plan and for the same period.
5. Bring the hospital's numbers to the negotiation, using payer results only as context.