The dilemma of how to ensure broad access to health services for the population and, at the same time, ensure sustainable financing of the system permeates the debate on how to balance relationships in the Brazilian health network, which includes the Unified Health System (SUS) and complementary health.
“In Brazil, we have universal access to some services, such as vaccination and organ transplantation, that are concentrated in the public sector. But our system is very fragmented, and there is a tendency to consider global systems to be more successful globally,” explained Eugenio Vilaca, Advisor to the National Council of Health Trustees (CONASS). ), at an event held by Casa jota In partnership with the National Association of Private Hospitals (Anahp), this Tuesday (2/8).
The painting was the first of A series of discussions on the future of health In Brazil to be held during the month of August in Casa jota. The next event is scheduled for Tuesday (8/9) and will discuss how to improve indicators and promote health innovation in Brazil.
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Despite this perception, a transition to this type of system, which exists in the UK, for example, cannot be feasible for the current Brazilian reality. In this model, there would be a mainstreaming of health care through public services, while in reality the private network would be complementary. However, this will require a doubling of the resource contribution to SUS”, Vilaça noted.
The other scenario is one that features some sort of managed competition, which already has trials in the Netherlands and Colombia. In this case, the public system provides services that rival private services. The Colombian experience is very controversial, because coverage has increased, but public health has worsened,” he said.
This hypothesis also would not fit Brazil, in his opinion. “Both models will demand drastic reforms that occur only in historic windows, as was the case with SUS in re-democratization,” he said. Villaca then proposes a third path, guided by reforms in the relations between the public and private systems.
Examples include strengthening the state’s regulatory capacity in delegating the provision of services – as in the case of hospital management by charitable organizations, which is the case today – and improving contracts, as well as monitoring their compliance.
We should think of complementary and general health as vessels of communication. They often compete for the same resources, such as investments and human resources,” said Arthur Aguilar, director of public policy at the Institute for Health Policy Studies (IEPS).
In his view, it is necessary to consider financing mechanisms that allow the transfer of resources to SUS services capable of solving problems at their root – such as changes in tax credits for the use of supplemental health by people with high incomes or changes in the transfer of state revenue to municipalities.
“But our main outlet is to look more at treatable problems. It is a symptom that almost all municipalities do not meet the goals of arteriometrics, which can prevent cardiovascular disease,” Aguillar exemplifies. “The basics are not being met, and it has a very significant health payoff, such as what we’ve observed with vaccination and the expansion of prenatal care for a series of indications,” he added.
Focusing on primary care can reduce costs and ensure the financial viability of the health system. “The most important thing is preventative care, with vaccination and infectious disease control initially,” said Claudio Lautenberg, chair of the board of directors at Albert Einstein Hospital at the Coliseo Side Institute. “In order to get adequate funding, it is impossible not to look at the complementary system, because as it grows, there are more resources that SUS is investing,” he added.
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