With the delay in the table of procedures of the Unified Health System (SUS), used for hospital services provided by establishments affiliated to the public health network, family expenses exceed government expenditures for the area, according to the Brazilian Institute of Geography and Statistics (IBGE).
Spending on the final consumption of health goods and services in Brazil reached R$ 711.4 billion in 2019, the beginning of the mandate of Jair Bolsonaro (PL). Of this total, BRL 283.6 billion (3.8% of GDP) were government expenditures and BRL 427.8 billion (5.8% of GDP) by families and non-profit institutions at the service of families.
According to the IBGE, the expenditure per capita with the consumption of health goods and services, at the time, was BRL 2,035.60 for families and BRL 1,349.60 for the government. The main expenditure by families was on public health services, which include expenses with doctors and health plans — corresponding to 67.5% of total expenditure on final health consumption.
The public service has a delay in the table of SUS procedures and experts criticize the funding model for resources destined for the area.
According to the Federal Council of Medicine (CFM), more than 1,500 hospital procedures are outdated — and the list could be even longer, if outpatient care is considered, not mentioned in the survey.
The accumulated loss in medical fees for certain procedures reached almost 1,300%, according to the body’s estimate, last made in 2015.
According to the survey, the doctor received R$ 10 for each outpatient consultation carried out in the SUS.
Medical fees for the treatment of liver diseases, such as hepatitis or cirrhosis, amount to just R$ 59.70, divided by the average length of stay of eight days for the patient. At the end of the treatment, it corresponds to a daily rate of R$ 7.46. From 2008 to 2014, the average daily payment was adjusted by only R$0.35. At the end of the comparison, by the inflation indexes accumulated in the period, today it would be at least R$ 10.50.
The SUS procedure table lists, for example, the remuneration values of almost 5 thousand medical procedures, ranging from outpatient care to more complex surgeries, such as heart transplantation.
In addition to the decades lag in the SUS table, experts also criticize the resource financing system, currently divided between the three federative entities — Union, states and municipalities —, and cite millionaire losses caused by the Amendment to the Constitution 95/2016, edited during the government of Michel Temer (MDB).
The text instituted a new fiscal regime in the country and imposed a ceiling on expenditures until 2036. During the period, public expenditures may vary only according to the inflation accumulated in a period of one year.
If the effects of fiscal austerity policies in the health area provided funding that was not adequate to support the demand registered in the SUS, with the amendment of the spending ceiling, experts point to underfunding.
A table that will be presented in July by the Budget and Financing Commission of the National Health Council (CNS) points out that the spending ceiling amendment caused the public system to lose almost R$ 37 billion in health resources since it was enacted. Francisco Funcia, Bruno Moretti, Rodrigo Benevides, Mariana Mello, Erika Aragão and Carlos Ocke-Reis participated in the study.
If in 2019 the government had applied the same amount that it applied in 2017 — 15% of net current revenue — the Ministry of Health would have a budget of around BRL 142 billion, not BRL 122 billion actually invested. That is, there was a shrinkage of R$ 20 billion on that occasion alone, according to the study.
In an interview with R7Councilor Getúlio Vargas de Moura says that, with the amendment of the spending ceiling, freezing resources for 20 years, the damage to SUS can exceed R$ 400 billion.
“The fact is that, historically, there has never been adequate funding for Health. The table has never been adjusted and, yes, always underestimated. It is what we always say that the SUS does a lot, with very little”, says Moura. “And this worries us because it transforms what should be government policy into state policy”, he adds.
The difficulties in achieving the volume of resources necessary to meet the demands of the population remain unresolved, but CNS specialists warn of possible alternatives.
For the consultant of the Budget and Financing Commission of the National Health Council and vice-president of the Brazilian Association of Health Economics, Francisco Funcia, the main problem in itself is not the lag in the table, but the financing of health resources. .
“The discussion of the SUS table is secondary to the resource financing model that the SUS adopts. Our suggestion is to take into account the health needs of the population and components so that a defined per capita value can be obtained, so that it meets to the system”, he defends.
According to Funcia, the country needs a value that enables the idea of per capita. “The United Kingdom invests around 7.8% of GDP (Gross Domestic Product) in health. We spend around 4%. And the per capita cost per day is close to R$ 4”, he reports.
In this shared way, the CNS counselor points out that the Union has been reducing its participation in health financing over the last few years. “Currently it represents less than half of everything that is spent, around 42%, while the municipalities, 32%, and the states, 26%”, he says.
In a note, the ministry reported that the values of the SUS table are constantly updated and emphasizes that it is not the only way to finance services. “The Ministry of Health transfers monthly, to state and municipal health funds, financial resources intended for the cost of hospital services of medium and high complexity”, he says, adding that, in 2021, R$ 45 billion were transferred and, in 2022, have already been R$ 16 billion.
The report questioned the ministry about the lags and values mentioned by CFM, but did not get a response.