The future of the Health System
As a result of the current catastrophe, caused by the coronavirus pandemic (Covid19), we may be at the most difficult moment for health in our country and in the world. Even the opinions of the most renowned specialists, infectologists and sanitarians differ in relation to the conduct of isolation or not, regarding the course of the process. Also, in relation to treatment, there are many controversies, but one thing is certain, several studies and clinical trials are needed before the disclosure of how we should treat these patients. It is from this aspect that we must be guided for the future.
Health requires investments and a lot of study. Let us look at the case of our country. The breakdown in public and private health brings different characteristics in terms of access, care, and treatment opportunities. While very little is invested in public health and the conditions of care in many places are terrible, without the minimum capacity to solve the problem, in other private ones, we have a better capacity than in many American or European centers.
Unfortunately, the “List of Medications” (Rename) of our “Unified Health Service” (SUS) is a pity. The lack of medicines in health centers is a constant, in addition to not having many drugs necessary for the good treatment of people. Consequence of this, a lot of judicialization of health for medications.
Another aspect is the lack of a career consistent with all health professionals, federal, state, and municipal. Like the judiciary, doctors, nurses, and dentists should have the minimum structure for their activities and remuneration. Take the example of São Paulo, the largest city in the country and the one whose GDP is the largest in our federation. There has been no salary readjustment for years, much less is it replaced by inflation in the period. It is a total disregard for health professionals. On the other hand, when we analyze the value of these remunerations, there is not a tenth of the value of judges or magistrates, in the case of doctors. Not to mention the workload performed by health professionals and the resolution of cases, which is much higher when compared to the judiciary.
Also, in relation to private health, remuneration remains a debacle and authorization for procedures is often denied. Of course, half the guilt must be clarified here. There are colleagues who abuse requests for unnecessary materials and add inappropriate codes to procedures. Fortunately, they are few and I think they are learning after suffering several negatives.
Regardless, the values of surgical procedures are not followed by operators according to the established by the “Brazilian Medical Association” (AMB) in relation to the “Brazilian Hierarchical Classification of Medical Procedures” (CBHPM). Each health plan pays what it wants to those who want it, and nothing happens. The “National Health Agency” (ANS), the regulatory body for private health in Brazil, does not interfere, or when it does, it logically benefits the stronger side.
From the point of view of hospitals, the need to establish protocols for care and conduct is becoming increasingly necessary. Unfortunately, the training of some health professionals today is poor, and there is, consequently, no appropriate conduct on their part. The number of medical schools is a bit daunting. The release a few years ago, for the operation of courses that do not even have a hospital for internship, propaedeutics and boarding school is a real absurdity. In addition, in many of these institutions there are not even qualified teachers for teaching, or even hours for many specialties. Here too, largely the fault of the Ministry of Education, which, in unreasonable curricular changes, partially destroyed the medical course.
The establishment of protocols, based on randomized, controlled clinical studies or guidelines, standardizing conduct in relation not only to prophylaxis and treatment, but also related to outpatient and hospital care should be charged to health professionals. Good medical practice should be prioritized.
What we can and what we would like to expect after the pandemic. There are those optimists, like Paulo Martins, who believe in general, that our society in particular and the world in general will emerge more aware of our fragility and this will lead us to a type of society that is more solidary, respectful and citizen. The human being, when in contact with danger, turns inward and, inwardly, begins to reflect how important the other is and has value; and, in that sense, how much otherness needs to be preserved. On the other hand, as mentioned by Fabio Faversani, for an important part of the population, the deaths will be the result of medicine that failed and of a science that does not serve society, but for obscure purposes. Do not be surprised that the same population, which today calls for a medicine or vaccine, will strongly reject it tomorrow. Or do not be surprised that the same people who today clap for the work of health professionals, in my view a great hypocrisy of politicians, tomorrow continue to turn their backs on the needs of public or even private health, the needs of better education and support scientific research.
Folha de são Paulo, 25 de abril de 2020, Tendências e Debates
Paulo Martins, professor livre docente de Letras Clássicas e vice-diretor da FFLCH-USP (Faculdade de Filosofia, Letras e Ciências Humanas – Universidade de São Paulo)
Fábio Faversani, professor de História de Estudos Clássicos
Dr. Marcelo Calil Burihan
President of SBACV/SP 2018 – 2019
Director of Publications – Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV/SP)