The crisis did not affect only the medical assistance of workers who had their positions terminated and no longer can count on private health insurance. For many of those who are still employed, the health insurance plans offered by companies are being reduced.

Three actions have been intensified this year: 1) companies which are trading health insurance plans and looking for operators that offer cheaper packages; 2) companies that are introducing co-participation models, in which employees pay for a part of their medical appointments and 3) companies which are reducing the number of benefits offered to employees with lower level hospitals and by changing individual hospital rooms for shared hospital rooms and reducing reimbursements.

A study by specialized consultants Mercer Marsh held at more than 500 companies showed that the impact of health insurance benefits on companies’ payrolls have increased to 11.54% in 2015 from 10.38% in 2012.

This year broker Aon registered an increase of 58% in the number of its clients looking for changes. Aon health technical director, Rafaella Matioli, says that 22% of her clients have decided to change health insurance companies in 2015. Cost reduction was one of the most cited reasons.

Grupo Fleury has recently adopted a co-participation system with its employees to “maintain the balance between the benefit’s cost and its reasonable and sustainable use,” says Eduardo Marques, a director of the group.

Senac São Paulo has excluded hospitals such as Sírio-Libanês and Einstein from the list available to its employees and their dependents. Folha contacted Senac, but it denied that an expense cost was the reason for the change.