Emergencies, cuts and epidemics reduce the number of outpatients in SUS

SUS (Unified Health System) outpatient care has declined over the past few years across the country. The average number of procedures Ambulance per capita income fell by 12% between 2015 and 2019, indicating a correlation with fiscal reductions. If we compare the data from 2020 and 2021, the loss compared to 2015 is even higher, up to 26%.

The system as a whole is based on the development of an outpatient report published by the Outpatient Data Center, SIA-SUS, of the Ministry of Health. Data can be consulted via the DataSUS portal. Search, the Department of Health reported, without giving information, which it understands that SUS “holds the average number of visits in recent years”, due to is “the expansion of services in the Personal Care sector”.

The first half of the decade was a period of growth. Between 2010 and 2014, total per capita health care coverage increased by 18%. However, from 2015 to the beginning began to decline, with a slight recovery in 2019 and 2021 – but still lower levels until 2014.

Data show that, in 2019, 3.7 billion outpatient medical procedures were performed, with an average of 17.9 per occupant. The total was 12% lower than 4.1 billion in 2014 – or 20.2 per capita.

The recession began to see more in 2016, especially when the country was facing political and financial turmoil. According to the ANS (National Supplementary Health Agency), that year 1.4 million Brazilians were no longer covered by health insurance.

The decline is expected to continue in 2020 and 2021. However, due to contagion, experts say the data should not be compared, because many processes have is delayed or postponed so that health services can treat patients. -19.

Or change, or reduce

Analysts have heard from a statement that fiscal consensus with EC 95 (Constitutional Amendment 95), in 2016, resulted in greater losses for the SUS during the national economy. trade declines.

“Even before that, it was already lower than people expected,” said Bernadete Perez, health officer, professor and researcher at UFPE (Federal University of Pernambuco).

For the professor, the reduction is part of the SUS shortfall, which, he said, leads to a loss of capital created by EC 95. “We are still in this period of a crisis. of networks, with less control, in addition to the spread itself has reduced services, says Perez, who is also vice president of Abrasco (Brazilian Association of Collective Health).

In terms of value, the production of outpatients has also declined in recent years, if at a lower cost.

“SUS is choosing and, with EC 95, it is likely to fall further next year,” said economist Erika Aragão, president of the Abres (Brazilian Association of Health Economics). Economist and professor at the Department of Public Health at UFBA (Federal University of Bahia), Aragão has been researching these topics for years and has argued that skepticism has undermined SUS. monitor.

Abres has completed, with a group of scientists, a study that estimates how much health has fallen since 2018 with EC 95, affecting previous financial models. .

  • 2018: – BRL 3.9 billion
  • 2019: – BRL 13.5 billion
  • 2020: + BRL 21 billion
  • 2021: – BRL 27.6 billion
  • 2022: – BRL 12.7 billion
  • Total: – BRL 36.9 billion

“We see a loss of almost R $ 37 billion, regardless of the investment from covid-19, in the amount approved and completed. In other words, there is a real loss,” said Aragão.

SUS - Marcello Casal Jr / Agência Brasil - Marcello Casal Jr / Agência Brasil
Photo: Marcello Casal Jr / Agência Brasil

According to the financial analyst, the country has a coalition that has the potential to expand services. “The numbers have dropped because SUS has not been paid and other policies, such as the Monetary Policy, have prevented the expansion of services,” said the analyst.

EC 95, he said, excluding people getting sicker and older, adjusting health care budgets only for inflation. “That is, if the country develops, the government will have more capital, but they will not go to the public economy. This decline is already a reflection of the process. Health measures have been approved, and EC 95 is the heaviest. ”, band.

Resources should grow according to the demand for healthy growth. People have fewer health problems. With minimal investment, SUS ends the cut [procedimentos] and those who need it eventually run out of service or wait longer.
Erika Aragão, Abres

The incident also affected financial institutions, such as Santas Casas, which claimed that SUS paid less than the cost of the process.

“For more than 20 years, SIGTAP table [Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Operações do SUS] Suffered no change in the results sent to the hospital, said Artur Gomes Neto, provider of Santa Casa de Maceió.

He said he uses the proceeds from the health care package to support public services. “The cost is lower than the need to minimize expenses,” he added.

Gomes Neto explains that outpatient development for SUS will cost an average of R $ 2.5 million in 2021, less than half of what was necessary to cover the costs alone. “We have to pay for SUS services with another R $ 57 million,” he added.

regional differences

The decline in SUS outpatients has had a significant impact on central health care, says Alcides Miranda, of UFRGS (Federal University of Rio Grande do Sul). Intermediate services are those that require specialized care by a health professional and simple experiments, such as radios and ultrasounds.

According to Miranda, in recent years there has been a further increase in what it calls “business associations” in this type of service.

In addition, he said, there has been an expansion in the provision of SUS services through OSs (Social Organizations) and others. He pointed out that “the reduction in the SUS network, both self-contained and interconnected, at the rate of increase in the non-SUS network, especially in the middle of ambulatory complexity” .

For Miranda, this leads to a kind of “opening up” of SUS, with implications that should only be seen better in the long run. One problem it points out is the increase in unequal areas.

An example: the availability of SUS mammograms has gradually focused on areas with better HDIs. [índice de desenvolvimento humano] and lower the area with the worst. Short-term analysis makes it difficult to report this, but in the medium and long term it is possible to report changes, ”he said.

The ten largest companies of external services for SUS in the process in 2021:

  • City or county – 1.442 billion standard
  • Federal or state agencies and DF – 1.41 billion
  • Non-profit organizations – 282 million
  • Businesses – 255 million
  • State capital – 24 million
  • The capital city – 21 million
  • Federal regulations – 19 million
  • Public consortia – 12 million
  • State police force -11.3 million
  • City police – 11.5 million

The largest service still exists on SUS personal network. However, there is likely to be a reduction, including the combination of a combination of joint ventures (approvals or commitments) and for state-owned enterprises. fraudulent management and privacy policy.
Alcides Miranda, UFRGs

What does the temple say?

The team sought the Ministry of Health to discuss the decline of outpatient medical procedures. The record only declares that it understands that SUS “dropped the average of visits last year”.

“An important part of the numbers to stay at this level is the expansion of services in Personal Care. With the rise of Basic Hospitals and health teams in Working families in the city, the demand for Specialized Care has always been reduced, supporting. folder, no need to send the number of the first visit.

The information used for the report, however, does not include hospital visits, such as a report from the Ministry.

Leave a Comment