Revolving doors and conflicts of interest in health regulatory agencies in Brazil

Exploring revolving doors in health regulatory agencies in Brazil We select the two federal health regulatory agencies linked to the Ministry of Health in Brazil: the National Health Surveillance Agency (ANVISA), which regulates drugs, food, cosmetics, tobacco, medical products and equipment, blood and blood products, hospitals and health services (box 1); and the National Agency of Supplementary Health (ANS), which regulates private health plans and insurance, including the relationship between these companies and suppliers, hospitals, diagnostic laboratories, physicians and private care users (box 2). Despite Brazil’s vast public and universal health system, there is a widespread presence of the private sector in the production, financing and delivery of health services.6 The private health insurance market in Brazil (the second largest in the world, after the USA) was estimated to be worth US$50.2 billion in 2018, and the Brazilian pharmaceutical market (the world’s sixth largest) recorded a turnover of US$21.1 billion in 2017. [...]there are major economic interests involved in the sectors regulated by both agencies. The most common management positions in the private sector were in health plans and insurance companies (n=4), private hospitals (n=4) and the pharmaceutical industry (n=3). According to the characteristics of the trajectory prior to working in the agencies (table 1), there were more professionals with health science education and who had previously worked within the Brazilian Unified Health System in the ‘public-public’ group than in the other two groups.