The June 2026 Anahp Observatory report has one central word: mismatch. Health plan operators are enjoying the best financial moment in the historical series. Hospitals, which deliver the service, still face falling margins and pressured cash. In the June 30 webinar, Felipe and Rodrigo Dellacqua discussed this picture. This text organizes what was debated.
The payers' side: a consistent recovery
Without the effect of an extraordinary provision booked by a large payer, the quarter's result would have reached about R$ 7.6 billion, with a net margin close to 8.8%. In 2025, the ten largest payers accounted for roughly 70% of the market's income.
The hospitals' side: more efficient, less profitable
Hospitals did their homework on care: they use beds better and discharge patients sooner. But the report itself acknowledges that these gains haven't been enough to offset financial pressures. The efficiency achieved at the bedside is lost on the way to the bank.
Where value is lost: three takeaways from the webinar
First takeaway: final denials are just the end of the funnel
The accepted accounting denial rate at Anahp hospitals was 1.61% of gross insurance revenue in Q1 2026, below the 1.87% peak in 2024. It seems small. But it is what remains after initial denials, disputes and team rework. For a hospital with R$ 100 million in annual insurance revenue, 1.61% equals R$ 1.6 million a year that never comes back, not counting the cost of recovering the rest.
Second takeaway: the hospital finances the payer
The average collection period fell to 73.84 days, and the average supplier payment period was 48.38 days. That's about 25 days of difference. In the same R$ 100 million hospital, this means roughly R$ 7 million in tied-up working capital, financed with its own cash or expensive credit.
Third takeaway: the bill has become more complex
Hospitals' share of care expenses fell from 54.0% in 2013 to 50.8% in 2024. Bundled payment gained ground, daily rates and fees lost weight in revenue (from 23.92% to 22.33% between 2023 and 2026) and other operating revenue already accounts for 25.32%. With more bundles, more contract rules and more self-insured plans (34.37% of insurance revenue), getting the bill wrong became easier.
The Accrua view
In the conversation, the founders argued that the main bottleneck in Brazilian hospitals is no longer clinical but financial and administrative. And that this bottleneck is essentially a data problem: contract, bill, medical record and payer rule need to be read at the same time, before the bill goes out.
- Check before submitting. Validating each item against the contract reduces initial denials and the rework that follows.
- Prioritize appeals by value. Not every denial deserves the same effort; the queue needs to be sorted by value and likelihood of recovery.
- Measure by payer. Payment terms and denials vary widely between payers, and the data becomes leverage in negotiations.
- Turn receivables into capital. Those who know each payer's payment history can access capital based on real risk.
The Observatory shows the system has recovered. The next step is to make that recovery reach those who care for patients.
Data source: Anahp Observatory Report, June 2026, with ANS data (Q1 2026) processed by Arquitetos da Saúde and the Anahp Hospital Indicators System. The base of member hospitals grew from 120 in 2023 to 199 in 2026, which affects historical comparisons.