publicado em 08/02/2012 às 14h12:00
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The difficult problem of health

Alberto Carlos Almeida is a sociologist and university professor, an expert in data analysis and research for the public and private sector

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Alberto Carlos Almeida, a sociologist and university professor
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Alberto Carlos Almeida, a sociologist and university professor

The most important thing is that this problem is. We must, first of all, define what is bad and that, therefore, need a solution. To be clear: the main problem of the Health System is the waiting time for appointments and tests. That time has nothing to do with time in the waiting room, but with the distance that separates the day that a citizen seeking health services for an appointment and the day on which the consultation occurs. Many readers may not know, but it is common in all parts of Brazil, to wait three months or more to the occurrence of the query. The users expect from the private one, two, maybe three weeks for an appointment, while the SUS users are rarely received by the physician prior to 90 days.

The Via Crucis is repeated in the next step, the exam. Again, the waiting time is incredibly long. Speaking of waiting three months for each of these steps is often generosity. I have been an eyewitness to a visit I made to a municipality in the vicinity of the Federal District where the waiting time for a consultation with a cardiologist or ophthalmologist was 9-12 months. Imagine a person with a problem as simple as looking tired to wait a year for a physician to receive and then have the prospect of going to wear glasses. This is nothing in front of people who die because they were not received by cardiologists. These people will enter the statistics of death from stroke or heart attack without ever having to news that the death would probably have been avoided if the medical consultation and examinations had been performed at the same speed in which they are made in the private sector.

As the wait for the patient, is equivalent to eternity, he ends up going to a hospital and is received, standing by a doctor in five minutes that measures pressure, pulse and takes the prescription medication. Many of us know many people who experienced it. Long ago, our maid received a prescription for medicine pressure, when he came to know later, with urinary tract infection. Hospitals are overcrowded because they play the role to replace consultation and regular review. In the end, not so neither one thing nor the other, but the patient is somehow satisfied.

In the public debate on the crisis of public health are always two solutions. One is putting more resources. It just happened through the regulation of the splice 29. Or it comes to improving management. I do not think the solution is in neither of these two measures.

The increase in resources has clear limits. Brazil already enjoys one of the highest taxes in the world, under any standard of comparison: it is the largest among the emerging countries, is the largest in comparison with developed countries, Latin America etc.. Besides the impossibility of indefinitely increasing the tax burden, health may be the most important problem, but it is not the only one. Government resources must be directed to other areas such as education, infrastructure, social policy, social security etc.. From any angle, under a more careful analysis or more generally, it is very difficult to argue that the solution of the waiting time for appointments and tests is the increase of resources allocated to health.

Better management also seems to be the solution. The problem of public health care is at the very tip: about the relationship between doctors and their work between doctors and their potential patients. It has nothing to do with the purchase of equipment, purchase of hospital supplies, things like that. The physician must devote to work and if it does not, he must be punished. That's where the old and familiar problem of agent and principal: SUS nobody owns, nobody tells us doctors, they are the agent, but no head, no make that the main serve the population. The media and the public already know the game pushes: the doctors say they are underpaid and have no resources to work, the governors admit, but obviously not say in public that doctors are missing systematically to work and can do nothing against it. No managed to solve it, is a typical principal-agent problem.

The United Kingdom, Anglo-Saxon, proud of its National Health System (NHS). SUS is the country that just exceeds the gross GDP. The Anglo-Saxons, we all know, are very different from us culturally. This is a population whose adherence to rules is infinitely greater than ours. The implication for the world of services is phenomenal: there is a duty to be fulfilled. That is why, due to cultural differences, we should expect that the functioning of the universal public health in that country is more efficient than ours. Kept constant all other variables, being raised in a culture geared to the services provides a better service offering. It's simple.

In the late 1990s, when Britain was still far from producing less wealth than Brazil, a careful survey of the NHS found that 90% of patients diagnosed with a severe version of breast cancer had to wait 62 days to start treatment. For severe cases of cervical cancer, the wait was 95 days for lung cancer, 91 days for the neck, 123 days for the prostate, 143 days. In Brazil, there are no statistics on the average waiting time for appointments and tests, much less for 90% of critically ill patients by types of cancer.

What the British case reveals, among other things, is the principal-agent problem. There is no possible control over the doctors, the problem is at the tip, is the waiting time. Additionally, there are endless financial resources. Currently, the NHS is going through an unprecedented crisis, with the prospect of closing hospitals and measures of gender. In the UK, this is attributed to an aging population and the emergence of medical tests and procedures more costly. Could be. In reality, no matter. The public system when it comes to financial resources, works like a sponge: The more there are, the more he demands, the more receive more calls. The 29th Amendment and its regulations are just one symptom of this logic without end.

Is there a solution to this problem and we are all before it. The solution, in Brazil, is in progress. Research Satellite Account for Health, IBGE has just shown that the private expenditure on health per capita is higher than its equivalent in public no less than 29%. The government spends 645 dollars a Brazilian with health, while the average spending on health care for every American is 835 reais. Here is the solution to the disrespect for the interminable wait for the death and morbidity in the queue: Brazilians will increasingly finance their health care privately.

Please do not wait for plans of a demiurge, new regulations or social pacts around the theme. The solution is individual and private. The solution is incremental, long-term and seemingly disorganized. To the extent that increasing per capita income, people will spend more on health care and will get rid of the public. This is an outcome as inevitable as exceeding the GDP of France and the gross GDP per capita in the UK. It's just a matter or time.

No public money or efficiency management to resolve the chaos of SUS or the NHS. The solution will be provided by individuals, private agents who, fortunately, thanks to the increase of their income, will pay for their own health care. It will be a reduced role for SUS, those who really care will not be able to pay for anything that is beyond a few visits to emergency ambulance services and vaccination. Until we reach that stage, we have to live with the promise that no permanent solution to the public health care. Forget it. It's impossible. The best, for those who do not believe in magic, is that this promise from one ear and out the other.

   Palavras-chave:   SUS public health problem    Consultations    Alberto Carlos Almeida    A sociologist   
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