As the SUS schedule gets older, household spending exceeds government spending on health

With the delay in the procedures schedule of the Unified Health System (SUS), used for hospital services provided by institutions affiliated with the public health network, household expenditures exceed government expenditures for the region, according to the Brazilian Institute of Geography and Statistics (IBGE).

Expenditure on final consumption of health goods and services in Brazil reached R$711.4 billion in 2019, the beginning of Jair Bolsonaro’s (PL) term. Of this total, R$283.6 billion (3.8% of GDP) was government expenditure and R$427.8 billion (5.8% of GDP) by families and non-profit organizations serving households.

According to IBGE, the per capita expenditure on consumption of health goods and services, at that time, was R$2,035.60 for families and R$1,349.60 for the government. The main expenditure of households was on public health services, which includes expenditures for physicians and health plans – equivalent to 67.5% of total expenditure on final health consumption.

The public service has delays in the SUS’s action schedule and experts are criticizing the funding model for the resources allocated to the district. According to the Federal Council of Medicine (CFM), more than 1,500 procedures in the hospital are outdated – and the list could be longer, if outpatient care is taken into account, not mentioned in the survey.

The cumulative loss of medical fees in some procedures reached nearly 1,300%, according to the agency’s estimate, which was last made in 2015. According to the survey, the doctor received 10 riyals for each external consultation performed at the SUS. .

The medical fee for treating liver diseases, such as hepatitis or cirrhosis, is just R$59.70, divided by the patient’s average stay of eight days. At the end of treatment, it corresponds to the daily rate of R$ 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 indicators accumulated in this period, today it will be at least 10.50 Brazilian reals.

The SUS Procedures table, for example, lists reward values ​​for nearly 5,000 medical procedures, ranging from outpatient care to more complex surgeries, such as heart transplants.

In addition to the contracts late in the SUS schedule, experts also criticize the resource financing system, which is currently divided between the three federal entities – the federation, states and municipalities – and cited the millionaire losses caused by the 95/2016 amendment of the Constitution, edited. During the government of Michel Temer (MDB).

The text established a new financial system in the country and imposed a cap on expenditures until 2036. During this period, public expenditures may vary only according to the inflation accumulating in a one-year period.

If the effects of fiscal austerity policies in the health field provide insufficient funding to support the demand registered in the SUS, while adjusting the spending cap, experts point to a lack of funding.

The table to be presented by the National Council of Health’s (CNS) Budget and Finance Committee in July indicates that the spending cap adjustment has caused the public system to lose nearly R$37 billion in health resources since its year. The study participants were Francisco Foncia, Bruno Moretti, Rodrigo Benevides, Mariana Mello, Erika Aragao and Carlos Oki-Res.

If in 2019 the government applied the same amount it did in 2017 – 15% of current net revenues – the Ministry of Health would have a budget of about R$142 billion, not the R$122 billion already invested. This means that there was a contraction of R$20 billion on that occasion alone, according to the study.

In an interview with R7, Chancellor Getúlio Vargas de Moura said that with the spending cap adjusted, and a 20-year resource freeze, the damage to SUS could exceed R$400 billion. “The truth is that, historically, there has never been enough funding for health. The schedule has never been adjusted, and yes, it has always been underestimated. That’s what we always say SUS does too much, with too little,” Mora says. “This worries us because it turns what should be government policy into state policy,” he adds.

Difficulties in achieving the amount of resources needed to meet the demands of the population remain unresolved, but specialists in the central nervous system warn of possible alternatives.

For the adviser to the Budget and Finance Committee of the National Health Council and Vice-President of the Brazilian Association of Health Economics, Francisco Foncia, the main problem in itself is not the delay in the schedule, but in the financing of health resources. “The discussion of the SUS schedule is secondary to the resource financing model adopted by the SUS. Our proposal is to take into account the health needs of the population and components so that a specific value per capita can be obtained, consistent with the system,” he advocates.

According to Foncia, the state needs a value that enables the idea of ​​per capita share. “The UK invests about 7.8% of its GDP (gross domestic product) in health. We spend about 4%. And the cost per capita per day is close to R$4,” he says.

In this combined way, the CNS consultant notes that the consortium has reduced its involvement in health financing over the past few years. “Currently it accounts for less than half of all that is spent, about 42%, while municipalities, 32%, and states, 26%,” he says.

On a note, the ministry reports that the SUS schedule values ​​are constantly updated and stresses that it is not the only way to fund services. He adds: “Monthly transfers to the Ministry of Health, to state and municipal health funds, and financial resources allocated to the cost of hospital services of medium and high complexity,” adding that in 2021, R$45 billion was transferred, and in 2022, R$16 billion were already made. . The report asked the ministry about the backwardness and values ​​mentioned by the Council of Foreign Ministers, but did not get a response.