AC Camargo Hospital, which has a nearly 70-year history of treating cancer in São Paulo, will stop serving SUS patients from December, worsening access to these treatments in the capital, São Paulo.
Currently, more than 3000 people in the state are waiting for vacancies at Cacons (High Complexity Assistance Centers in Oncology), organized by the cross platform (Center for Health Services Regulatory).
The main reason for the end of public care, according to the foundation, is delays in the SUS schedule for consultations, procedures and surgeries, which means that every year the hospital has to make its own resources to cover the gap. Other areas, such as dialysis, are facing a similar crisis.
In 2021, for example, SUS revenue was R$36 million and AC Camargo had to pump another R$98.46 million, coming from private sponsorship, to close the bills. The Corporation’s net revenue in 2021 amounted to R$1.32 billion.
Opened on April 23, 1953, AC Camargo was the first hospital in the capital built with donations from residents. He was not affiliated with any official health institution, he had no financial support from religious organizations, and he was not sponsored by immigrant colonies, as was customary at the time. Over time, it has also become an international reference in cancer teaching and research.
The foundation, run by the Antônio Prudente Foundation, named for its founder, reported the decision to the Municipal Health Service earlier this year, with which it has a contract until December 9 this year. Resources from the Ministry of Health come directly to the municipality, which takes them to the hospital.
The Municipal Health Department said in a note that it was informed by the institution not to renew the contract and said that it had held meetings to assess the possibility of continuing care through the partnership.
The administration emphasizes, however, that oncology care for patients in the municipality’s network will continue to be provided through other municipal service providers, such as Hospital Municipal Dr. Gilson de Cássia Marques Carvalho-Vila Santa Catarina, and other units organized through the state’s government cross (Center for Health Service Supply Organization).
In response to a question about the lack of amendments to the SUS schedule, the Ministry of Health said that “the schedule is not the main or the only way to fund the SUS” and that “the values are minimal references, and can be supplemented by state and municipal administrators as per the demands and needs of each territory.”
About 1,500 of the 6,500 SUS patients under the supervision of AC Camargo have already been transferred by the municipal administration to cancer centers in the capital. According to the hospital, another 5,000 are expected to be referred by December.
In recent years the institution has been reducing the number of new patients seen by SUS. In 2017, for example, there were 1,500. In 2022, the number of new patients reached only 96, and this year nearly 7,000 new patients entered through the private door. In total, about 230,000 are served annually.
Until 2017, AC Camargo had a five-year contract with the city of São Paulo (Cebas, Certification of Charitable Social Assistance Entities), which provided for allocating 60% of its services to SUS.
According to Victor Piana de Andrade, CEO of ACCamargo Cancer Center, with the increasing delay in the SUS schedule and the increased demand for health plans, in 2018 the foundation chose a new contract model, which allowed it to adjust the percentage annually of SUS care according to special demand. The agreement was approved by the attorney general’s office, but the accounts were not closed.
“I am responsible for managing resources well, to ensure that the accounts are balanced. Oncology is expensive, medical inflation is higher than common inflation, and with the SUS schedule set for 14 years, with costs rising, I cannot bring that risk to the organization.”
He cites an example of being late. SUS pays R$10 for a medical consultation, while insurance companies, on average, R$100. The values of chemotherapy and radiotherapy sessions reimbursed by SUS are 94% and 71%, respectively, lower than those reimbursed by health plans.
According to Andrade, the mission of the Foundation is to improve oncology in Brazil and this is not limited to public services. “If I have a great deal of private care and use that to train 130 professionals every year, I do it very publicly. When I have research that makes treatment cheaper, it’s very public.”
He says the hospital tried several alternatives before deciding to end care. It tried, for example, to be part of Proadi, the federal government’s program to support the development of SUS which includes among its partners the Albert Einstein and Sírio-Libanês hospitals.
We got a technical yes [do Ministério da Saúde] Not a political decision. We tried a few times, we had very interesting projects, but we just couldn’t. We understand that this door was closed.”
According to Andrade, due to underinvestment in cancer prevention and early diagnosis, the public sector currently runs lines for advanced cancer patients. “We are left with a reverse selection. We take care of advanced and complex patients. The success rate is lower. It is very frustrating.”
The hospital also faced another challenge with patients with SUS. Because of the bond that was created with the foundation or lack of access to other health services, they ended up looking for AC Camargo for other health issues not related to cancer. “If he falls on a motorcycle, he wants to qualify here. If he’s diabetic, he wants to qualify here.”
According to the Atlas of Cancer Care Centers, of the Oncoguia Institute, 53% of the public resources AC Camargo received in 2021 went to oncology. The rest, according to the hospital, was to address the cancer patient’s other health issues.
“If the patient had already finished cancer treatment, they would have been referred to a UBS near their home for follow-up. We should have always done that, but we haven’t. We’ve spent 70 years cuddling like a mother,” Andrade says.
The hospital even proposed to the city of São Paulo to become a reference for oncology in the city, treating only very complex cases. For example, you will work on patients who are already associated with other public hospitals and after that you will continue to follow them in these institutions. But it was also unsuccessful. Currently, there are talks with the state government about possible partnerships.
At the same time, the Foundation is developing a national project, called the AC Camargo Mission, which will involve public authorities and the private sector in measures of prevention, diagnosis, treatment and rehabilitation, as well as the training of specialists in primary care and hospitals to provide cancer care.
“We are repositioning our social responsibility to gain a larger geography and a larger population. We want to use our influence, our credibility, and our resources as well to build an ecosystem of cancer care.”
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