AC Camargo renews the contract and maintains the services of SUS – 01/05/2023 – Equilíbrio e Saúde

a AC Camargo Hospital He renewed the contract with the city of São Paulo for another 12 months and will continue to serve cancer patients from the SUS, but under more restrictive conditions than before.

last august, the binding He revealed that the institution, which has a 70-year tradition in treating cancer, decided not to renew the contract with the municipality Because of the discrepancy in the SUS schedule. a The state government announced it You will provide financing complementary, But this did not happen.

The agreement with the municipality was signed on December 9. The number of new vacancies increased from 96 to 124, but it now focuses on five types of cancer: lung, brain, eye, bone marrow, and liver (in the latter two, treatments include organ transplants). The previous list also included tumors of the head, neck and abdomen.

The new contract provides for an amount of resources of R$54 million, R$19 million above the amount paid by the City Council in 2022 (R$35 million). The justification is that, in addition to the increase in vacancies, the cost of the first year of treatment is much higher than in subsequent years.

In the previous model, the hospital deficit with SUS services amounted to R$98.5 million. To close the accounts, the foundation says it used resources from private services. Now, the deficit is R$9 million. The net revenue of the hospital in 2021 was R$ 1.32 billion.

The decreased deficit also occurs because the institution has discharged nearly 2,000 SUS patients from oncology. In early 2022, there were 6,500; Now there are 4,498 registered.

According to Victor Piana de Andrade, CEO of the Acamargo Cancer Center, the hospital has had 130,000 SUS patients throughout its history. “Since 1953, we’ve opened medical records and never closed them. We’ve done our homework, seen who’s been cured for ten years, who’s disengaged more than five years ago, and we’ve discharged patients.”

The contract also states that SUS patients will remain in the institution until they are discharged from cancer, but that any urgent and emergency care they need will be carried out by UPA Vergueiro, located near the institution.

Andrade says all patients have already been informed of the changes and that UPA’s medical team has undergone training to identify, through signs, symptoms and tests, which cancer emergencies are not.

“When it comes to oncology, UPA transfers that patient to AC, we acknowledge and care for him here. And when that’s not the case, UPA gives the normal destination you would give any other patient.”

He says that, previously, there have been cases where patients in the institution have fallen from a motorbike, sustained burns, worsening kidney failure or complications from diabetes, for example, and have gone straight to AC Camargo’s emergency room. Due to a lack of vacancies in general hospitals, the hospital ended up accepting them.

to me Atlas of cancer care centers, from the Instituto Oncoguia, 53% of the public resources AC Camargo received in 2021 went to oncology. The rest went to treat the cancer patient’s other health issues.

“We felt hurt because our mission is oncology, and our resources are not limitless and I need to use them for oncology,” Andrade says.

According to the CEO, the alternative that has been presented to the City Council to maintain the agreement is that AC Camargo will continue to care for patients – through surgeries, radio and chemotherapy – but when cancer treatment is finished, they will be referred to other institutions.

“It is a model that the state is already adopting. Many small municipalities cannot take care of cancer, patients come to Icesp (Cancer Institute of the State of São Paulo), for example, and when the treatment ends, Icesp takes them back to them so that the municipality continues to care for them.”

According to Andrade, the position of the hospital providing non-oncology care to patients was worse than the discrepancy in the SUS schedule, from the point of view of the institution’s financial sustainability.

“It’s not the oncology, the chemotherapy, the radiotherapy, the big problem. It’s the extended hospital stay. And when we do that for non-cancerous cases, there’s a conflict with the institution.” [Antonio Prudente, mantenedora do hospital]targeting cancer.

Regarding the fact that the vacancies are limited to five types of cancer, Andrade says that AC Camargo provided the municipal health department with a list of tumors that the institution could treat, and it was the city council that decided which ones would be entered into the new contract.

On a note, the municipal health department says this option was introduced because the hospital’s care in neuro-oncology, pulmonary oncology, eye tumors and hematology are the only municipal network references in these areas.

The file also indicates that he has made all necessary efforts to ensure the continuity of treatment for cancer patients in the municipality’s network. It is also mentioned that in May 2022 the Bruno Covas Oncology Center was opened, which offers highly complex treatment, including robotics, which is unprecedented in a municipal hospital in the SUS.

He pointed out that “the unit has the capacity of outpatient clinics to accommodate 10,000 patients per month, in addition to conducting 8,000 radiological examinations and 450 surgeries.” When asked about the current waiting list for SUS patients awaiting diagnosis and treatment in the municipality, the Secretariat did not respond.

Last year, he was among the nearly 2,000 people discharged from cancer at AC Camargo Luciana Magri, 48 years old, from Praia Grande (Sao Paulo coast), had a neuroendocrine tumor and metastases in the lung, liver and pancreas, and was under palliative care. A patient in the hospital since 2007, she received the notice via email.

After filing a lawsuit, she won, in the first instance, the right to stay at AC Camargo and compensation for moral damages in the amount of R$5,000. The hospital appealed the decision arguing, among other things, that since Luciana is in palliative care, Luciana no longer needs to be attached to the institution and that she can be helped in the municipality where she lives.

“It was a grueling process,” he says. “The oncologist who keeps seeing me is the same one who got me out. Animosity has developed that is difficult for me from a psychological point of view.”

According to ACCamargo, the patient’s medical history underwent a careful re-evaluation, based on clinical and institutional protocols, and the previous decision to be discharged from cancer was correct.