of improvement in the indicators, as a result of a countercyclical fiscal policy implemented over the year with various fiscal relieves that ensured the retaking of consumption and economic growth. The supplementary health should follow the new economic cycle and to expand. In 2009, some mergers and acquisitions shook the industry as the cases of Amil/Medial, Bradesco/Odontoprev and Unibanco/Tempo Participações, what demonstrates the increasing need for scale and operational efficiency to ensure business success. ANS has set in 6.76% the maximum readjustment for individual/family medical-hospital health plans contracted from January 1999, the so-called new plans. Insufficient to cover the increased costs, measured by Variation of the MedicalHospital Costs (VCMH) calculated by the Institute for the Studies of Supplementary Health (IESS) that was 14.2% in 2008. Accordingly, although the sub-readjustment is not an innovation in the market at a time of crisis may cause meaningful financial damages. For 2010, it is a matter of concern the intent of ANS to bind the adjustment to the Performance Index in Supplementary Health (IDSS) of the qualification program. Despite of FenaSaúde has repeatedly insisted in the precariousness of the indicator and in the mistaken policy of ANS, the program went on. The 2009 evaluation had a new indicator relating to the health promotion and risks prevention and diseases programs approved in ANS. Furthermore, the indicators of reimbursement proportion to the SUS and fluctuation rate of the number of beneficiaries were excluded from the Structure and Operation dimension. In the economic-financial and satisfaction of beneficiaries dimensions, the same indicators were kept. Also in 2009, we may highlight the intensification of the relationships between operators and medical providers with the return of the threats of strikes in the service and boycott to the health plans. The medical movement rebounded nationwide in the case of the pediatricians of the Distrito Federal, where the Ministry of Labor intervened seeking not only to collectivize the negotiations, but also to establish parameters for adjustments and periodicity. Within this context, the bench of health present in the National
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Congress intensified the work for the progress of the Bills that affect the sector, especially those that amend the Law no. 9656/1998, such as the substitutive of the Bill 4076/2001. FenaSaúde participated actively in the process of the Bills and amendments, with opinions, proposals and studies. It also participated in the discussions that culminated in public hearing at the Committee on Social Security and Family to discuss the Bill 1220/2007, which obliges health plans operators to comply with the tables prepared by representative entities of the categories. Another Bill that arises from the medical class was the Bill no. 39/2007 in the Chamber, and that was also subject to public hearing in the Committee on Economic Affairs of the Federal Senate, and which seeks to regulate the negotiation of the remuneration of the doctors by creating a list of procedures with values. The main project of the Federation, in partnership IESS, was initiated in 2009, relating to the establishment of structured and standardized terminology for the Orthosis, Prosthesis and Special Materials (OPME), particularly in orthopaedic area. This will be an important tool for managers of the associated. FenaSaúde led the composition and meetings of the technical boards for understanding with the purpose to standardize concepts for implementation of the Notification of Preliminary Investigation (NIP). We also participated actively in the Working Group on OPME formed under CNS. FenaSaúde, it is important to remember, will be the holder representative in the Council over the next three years. In institutional terms, the Federation continued the meetings with the representative bodies of the market, namely: Brazilian Houses of Mercy Confederation, ABRAMGE, UNIDAS and UNIMED, besides participating in the meetings of ONA and CBA. Even with regard to accreditation, the Federation participated in the initial meetings about the project for the accreditation of operators which ANS plans to regulate in 2010. The Federation has also undergone important changes over 2009. In February, the President of FenaSaúde, Dr. Luiz Carlos Trabuco Cappi (Bradesco Saúde), submitted a Letter of Resignation to the Board of Directors due to his new