The Unified Health System (SUS) supplies analysis of its issues and quite a few resolution proposals shared by these discussing the Brazilian well being system. The options face a variety of political challenges, making it troublesome to implement modifications that might profit SUS. But, earlier than coming into into this dialogue, it’s crucial to summarize which proposals make it potential to enhance the availability of SUS providers.
But what political challenges want to be overcome to allow the implementation of those modifications in SUS?
First, there’s a battle between the private and non-private sectors within the provision of well being providers. Although the Constitution establishes that now we have one, public and common system, in follow, plainly now we have two methods: private and non-private that compete with one another. This house dispute causes waste, fragments the SUS and harms the well being care of the inhabitants. A dangerous impact of this competitors is the tradition that the “consumption dream” of the inhabitants is a personal well being plan, as a result of the SUS doesn’t work and is meant for the poor, who don’t have any selection due to the dearth of it. Evidence of this revenue is union negotiations whose precedence is to assure a personal well being plan for his or her members. SUS wants to be of worth to Brazilian society, as a result of National Health Service (NHS) It is for the English inhabitants, in any other case we will be unable to overcome their shortcomings.
Brazil has a big non-public sector in well being, rating second rating In the world, second solely to the USA. This is a actuality that wants to be taken under consideration whereas formulating public insurance policies within the sector. Private sector participation in SUS ought to happen inside a regulation that preserves constitutional rules. The Ministry of Health wants to promote negotiations with all these on this subject so that everybody’s place may be clearly outlined, making an allowance for the curiosity of SUS customers, effectivity and cooperation between the 2 sectors.
Potential options from the non-public sector are already born with a elementary flaw, as they solely mirror the curiosity of increasing their market to the wants of the SUS. In this context, it isn’t clear whether or not this resolution improves the entry and high quality of well being providers within the nation, in accordance to the constitutional teachings. This is the case of current proposals to create networks to present well being plans or counseling providers, which, opposite to what their proponents advocate, improve waste and fragmentation of the system.
In this debate between private and non-private areas, some use the simplistic argument that the bigger the non-public sector, the decrease the demand for SUS. It does not work that approach in international locations with public and common methods. The non-public sector is complementary to the general public sector. Additionally, the inhabitants doesn’t have the revenue to pay for medical health insurance. Data reveals that 75% of Brazilians rely solely on SUS, and within the northern area of the nation, this quantity reaches 90%. Improving entry to well being providers will not be as simple as this argument makes it appear. On the opposite, it’s going to have to endure a discount within the dimension of the non-public sector and, consequently, the expansion of the general public sector.
However, the dialogue that pursuits the Ministry of Population and Health is how we’ll manage the availability of providers that meet the well being wants of residents all through their lives in all areas of the nation in accordance with constitutional rules. legal guidelines and with the participation of all who can cooperate.
Another problem is the dearth of administrative continuity when there’s a change in authorities. This trade doesn’t often assure the continuity of public insurance policies. My expertise as head of the Espírito Santo State Health Department (SESA-ES) between 2015 and 2018, leads me to say that if the three successive governments on the federal, state and municipal ranges keep a coverage that addresses the structural challenges of the listed SUS. Above, we will likely be in a position to make leaps in high quality within the provision of providers to the inhabitants. In different phrases, it takes 10 to 15 years of continuity in public well being insurance policies to create efficient and structural options.
The third is the quick-time period expectation of the inhabitants. Millions of individuals search SUS providers each day and want instant options to their well being issues. This large quick-time period demand and difficulties in accessing providers guides the political debate. Therefore, so as to achieve the help of the inhabitants and politicians to drive the mandatory modifications, we can’t solely consider medium and lengthy-time period structural modifications. Meeting the necessity for consultations, examinations and surgical procedures requires quick-time period initiatives, resembling a tried-and-true coverage of collective efforts. However, structural modifications want to be applied in addition to quick-time period modifications, in any other case we’ll proceed to delay addressing difficulties in accessing well being providers.
Structural modifications additionally produce instant outcomes, however on a smaller scale. Initially, few customers will likely be served by the brand new mannequin, however over time all will likely be served by it.
A fourth problem refers to the multiplicity of actors in society and in any respect ranges of presidency, which intervene with well being insurance policies and their budgets. I spotlight, above all, the judiciary, public ministries, audit courts, legislative branches, skilled councils, associations and unions of individuals with ailments. Some management organizations have the authorized authority to decide prices exterior of government planning, and others management administration primarily based on an emphasis on processes slightly than outcomes.
It will not be a simple activity for a public supervisor to articulate this set of political, financial, institutional and company pursuits. Even extra so, when for the inhabitants and the media, via a easy evaluation, just one particular person is liable for the difficulties in accessing well being providers, which is the general public supervisor on responsibility. However, if now we have political management with readability about what wants to be carried out, it’s potential to construct political help to drive quick-time period outcomes and structural modifications. Public insurance policies working in varied governments and throughout the nation mirror this.
This complexity attributable to the existence of a number of actors and their pursuits, regardless of its relevance, is little thought-about within the public debate, because it imposes restrictions on the pace of enhancing the standard and effectivity of well being providers. On the opposite hand, it imposes democratic and clear governance which is the energy of SUS. Legal norms that regulate management relationships between public establishments want to be reformed to facilitate the manufacturing of ends in well being take care of the inhabitants.
In abstract, to assure public and common entry to well being providers, merely making a constitutional proper will not be sufficient, political challenges to its implementation have to be overcome.
Ricardo de Oliveira is a manufacturing engineer and was Espirito Santo’s Secretary of State for Management and Human Resources from 2005 to 2010. Secretary of State for Health of the ES from 2015 to 2018. Author of the books: Gestão Pública: Democracia e Eficiência, FGV/ 2012 and Public Management and Health, FGV/ 2020. Counselor on the Institute of Studies for Health Policies (IEPS). Member of the Philanthropy Committee of UMANE.