The crisis in AC Camargo and the closing of hundreds of Santas Casas reveal a fascinating public health drama. José Carvalho de Noronha affirms: The solution is complex, but possible – as long as the lack of funding is overcome
The worrying news that AC Camargo Hospital, a reference in cancer treatment in São Paulo, would no longer serve the SUS, has had repercussions. So much so that the city council, which initially downplayed the loss, returned three days later. And adjusting remittances so that the partnership is not dissolved. The crisis was overcome with the city’s resources, but the central issue was still far from resolved. In an interview with other healthJosé Carvalho de Noronha, a public health physician and researcher at the Health Information Laboratory (Lis/Icict) in Fiocruz, explained the critical aspects of understanding and thinking about them.
The central point of the problem is the transfer of public resources to hospitals and other private providers serving SUS users. It is done through two mechanisms: tax assignment and money transfer, according to a schedule that pays for procedures, consultations and surgeries, and defines the values of each one.
The SUS table, the values of which determine the state, is the subject of discussions and questions. Due to the supposed delay, AC Camargo has nearly ended its partnership with City Council. It actually ceased being a charitable entity in 2017, and the number of patients treated by SUS is declining. A similar problem is occurring with the country’s dialysis network, DeVita, which serves 14,000 patients through SUS and threatens to terminate the contract. – Especially after the nursing salary limit is approved.
But Noronha stops at the problem of charitable entities. They are responsible for a very expressive portion – about 40% – of hospitalizations at SUS, and they need to devote 60% of their care to this. They are in crisis: in the past five years, more than 500 enterprises have closed their doors And there is a deficit of R$10.9 billion in the sector, according to the Federation of Santas Casas de Misericórdia, Hospitals and Charitable Entities (CMB).
Noronha acknowledges: There is, in fact, a difference between what private providers are paid by SUS and health plans. The rules are different. Operators pay an average of five times what the Ministry of Health pays. On the other hand, the state offers tax exemption, which is about R$15 billion annually. For the researcher, who was previously the Minister of Health Care in the Ministry of Health, the SUS schedule should be re-evaluated in detail, to correct possible abnormalities and make it more balanced. The partnership with Santas Casas – the primary providers of SUS, and important to ensuring its universality – must be improved. This, of course, involves eliminating “wretched people” who misuse public money. But what is essential is increased coordination by the Ministry of Health.
“We can’t allow 5,668 health systems” – one for each municipality – to keep their lights on. Half of healthcare funding comes from resources transferred from the Department of Health to states and municipalities. But today this relationship occurs in a disorganized manner. Municipalities such as São Paulo can supplement the funds transferred by the union and conclude agreements such as the one that maintained the agreement with AC Camargo. Most of them can’t. Some changes can resolve these disparities. First, it is necessary to review the values \u200b\u200bthat the table exercises, but in a selective and judicious manner. Some may be outdated; Others do not.
But it is possible to get past that, which makes the relationship more complicated. There are several ways to do this. The table can be condensed and reassembled. Hospital fees can be differentiated according to the complexity of the service – encouraging the continuation of outstanding institutions such as AC Camargo. Santa Casas reference can be created in certain regions. Financial incentives should include hospitals that decide to provide 100% care through SUS.
However, for all this, it is necessary to resolve the fundamental issue, Noronha stresses: the lack of public health funding. In the event of a shortage, SUS will not breathe to establish a new relationship with its providers. You will live from one crisis to the next, like the current one. And money is not enough. In addition to allocating a greater proportion of GDP to health, it takes a competent and committed administration from the ministry, whose excesses under Bolsonaro were odd.
There are no magic solutions, Noronha confirms. “Finish the table” will result in equally rewarding organizations that offer very different volumes and quality of service. This will lead to a deterioration in population care, as hospitals will soon realize that it is possible to receive more resources with fewer procedures.
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