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publicado em 07/08/2012 às 20h46:00
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The severity of the intervention of health plans in medical practice

Sandra Franco, a lawyer specializing in Medical Law and Health, effective member of the Committee on Health Law and Medical and Hospital Liability of OAB / SP and President of the Brazilian Academy of Medical Law and Health (ABDMS).

 
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Sandra Franco is the president of the Brazilian Academy of Medical Law and Health
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Sandra Franco is the president of the Brazilian Academy of Medical Law and Health

The Paulista doctors may suspend elective care to beneficiaries of seventeen health plan operators. The decision will occur after the evaluation of operators' responses to the claims made by professionals who will meet next on 09 August. The claims submitted by physicians impress, to the extent that adjustments are not limited to consultation and inclusion of clauses in contracts for periodic adjustments to provide medical services.

The request for adjustments in itself would be remarkable for the threat of strike, behold, today, some health plans pay for instance, around $ 10.00 for the procedure electrocardiogram, according to the National Federation of Doctors (FENAM) .

But the mobilization of doctors aims to draw attention to the pressures made by some health plans, which could be classified, at least unethical.

In therapeutic intervention, such as requests for reduction of exams, request high early with the aim of reducing hospital costs, surgical replacement of materials, among other claims, could be key measures of cost management, since they do not bring harm to patients. Doctors also complain of the lack of criteria for escalation in procedures, the lack of criteria for accreditation, the accreditation, the glosses, facts always present in everyday life and that interfere with their autonomy.

In this context, the population must evaluate the claims of doctors, to the extent that it is operational medicine in its full form, without restrictions on exams and need to stay in hospital.

Patients must have medical services provided to excellence and is not disputed that the values ​​perceived by doctors today are really outdated, a fact which in itself causes harm to patients, for doctors' fees reach worthy to survive, ultimately reducing the time consultation to meet more patients.

Also it would be reckless not to consider the reasons for operators seeking to reduce their costs, there would also, by some doctors, a certain ignorance about the cost of health care? Will be positive for all actors in this scenario, the approach to reviewing protocols according to evidence-based medicine and to assess what is necessary and possible in the universe of private healthcare.

Recently, the National Health Agency (ANS) has suspended several health insurance carriers for breach of standards. Should we not also a strict supervision on the objections of doctors about the pressures to reduce testing and early high? In order to evaluate the veracity of these allegations, serious merit, public authorities, regulatory agencies and professional bodies (such as the Medical Board) need to focus efforts.

The dialogues on the existing model of health insurance is essential for the improvement of services of health plans, which have seen the fabulous growth of beneficiaries, which migrate from the problematic and complex public health system. Doctors warn: it is the duty of all to seek improvement in attendance, each using their means. Health, public or private, is everyone's right!

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   Palavras-chave:   Supplemental health    Medical law    Health care    The National Federation of Doctors    FENAM   
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