REGULACIÓN UNIFORME, REALIDADES DESIGUALES: LA TERRITORIALIZACIÓN DE LA SALUD SUPLEMENTARIA EN EL ESTADO DE AMAZONAS COMO INSTRUMENTO DE EQUIDAD REGULATORIA Y EFECTIVIDAD DEL DERECHO A LA SALUD

Abstract

Brazilian supplementary health regulation establishes nationwide obligations, although their implementation takes place across territories characterized by different healthcare, geographic, technological, and socioeconomic conditions. This article aims to examine the need to incorporate territorial criteria into supplementary health regulation as a means of promoting substantive equality, the effectiveness of the right to health, and the sustainability of the sector, using the State of Amazonas as its territorial scope. This is a qualitative, exploratory, and descriptive study based on a literature review, documentary research, and the analysis of secondary data obtained from official databases, particularly those of the Brazilian National Regulatory Agency for Private Health Insurance and Plans (ANS). The results revealed a high concentration of private health plan beneficiary records in Manaus and significant gaps in healthcare provision across the health regions of Amazonas, within a context characterized by vast distances, logistical difficulties, unequal availability of specialized services, and connectivity limitations. The incorporation of high-complexity technologies into the ANS List of Health Procedures and Events further highlights the distinction between mandatory coverage and the territorial availability required for its effective provision. The study concludes that preserving a uniform national core of rights does not require absolute uniformity in the regulatory instruments used to ensure their implementation. Accordingly, the article proposes a territorially sensitive national regulatory approach, grounded in regulatory equity and objective criteria, capable of considering territorial specificities without reducing coverage or transferring the consequences of structural deficiencies in healthcare networks to beneficiaries.