Private unit executives complain of delays in the amounts paid by the government for procedures for patients with kidney problems; States claim that readaptation is the sole responsibility of the Union
Three times a week, 81-year-old retired Leda Kani goes to Perdizes, west of Sao Paulo, to do dialysis in a private clinic at the expense of Single health system (SUS). “It’s a grueling routine,” she says. She started treatment in 2020 after eight years with kidney problems. The elderly woman did not want to undergo therapy, but she was convinced by a doctor. “All the discomfort I felt, I don’t feel anymore,” she says.
The amount paid by the SUS, however, is insufficient to pay for the hemodialysis of 112 thousand patients in the public network who, like Leda, are treated in private clinics. Today, private units are already talking about closing or reducing vacancies if there is no readjustment in this relocation, according to clinic managers interviewed by the Estadio.
Retired Leda Kani, 81, undergoes dialysis sessions at a private clinic in western São Paulo Photo: Daniel Teixeira / Estadão
The sector is lobbying public authorities for a surcharge of up to 47% over the R $ 218 paid today for the treatment session, an amount fully paid by the Ministry of Health in most units of the federation. At least three states – Rio de Janeiro, Santa Catarina and Mato Grosso do Sul – still complete the amount requested by the clinics.
In the Federal District, medical units have asked for a reduction of up to 25% in the number of visits to the public network. The Gaúcha Society of Nephrology, on the other hand, has sent a letter to the state government saying that the clinics will not have “basic conditions” to meet new patients or make appointments from October onwards.
The largest dialysis network in Brazil, DaVita, with 91 units in 15 states, is also threatening to abandon SUS and is calling for public authorities to report readjustments within the next month – the multinational serves about 14,000 SUS patients, about 10%. of dialysis patients in the country.
São Paulo, Distrito Federal and Rio Grande do Sul are facing the largest gap to the table paid by the Ministry of Health, between 44% and 47%, according to the Brazilian Association of Dialysis and Transplant Clinics (ABCDT).
“Because clinics are less financially sound, they have even fewer resources to maintain patients’ quality of life. There are more people hospitalized for vascular access infections and other problems that were previously better resolved,” he warns. nephrologist Dirceu Reis, who chairs the Gaucho Society of Nephrology.
Dialysis is a therapy that replaces the functions of a deficient kidney, and about 112,000 SUS patients with chronic kidney disease depend on private clinics for treatment, says ABCDT, which blames inflation, the dollar, and the high price of inputs, for the more imported, due to the asphyxiation of the industry.
The private sector manages two thirds of the 1,325 establishments that provide the service to the country’s public network, according to data collected in the DataSus report of the Ministry of Health.
“Clinics, in this situation, do not invest in maintaining the quality of services, such as the periodic change of equipment, ranging from the simple air conditioner to the dialysis machine itself, in addition to the reuse of supplies. There is a vicious circle because maintenance an older car costs more, “explains nephrologist Yussif Ali Mere, president of ABCDT, who fears seeing the units go bankrupt due to lack of funds. From 2016 to today there were 40, the association estimates.
At the end of 2021 and after five years without readjustments, the ministry increased the amount paid for hemodialysis by 12.5%, from R $ 194 to R $ 218, but the transfer was unable to cover the costs that are grown over the period and continue to rise, says Ali Mere.
This has escalated cases of hospitalization for dialysis of patients with kidney disease who find no vacancies in the clinics, according to Dirceu Reis. “In the last week, ten patients were admitted only to the reference hospital where I work”, says the doctor, from Porto Alegre.
For Estadio, the Rio Grande do Sul health department admitted to the problem, but said there are vacancies for outpatient dialysis in the state. “If it is not possible to (be cared for) in your referral service, (the patient) is promptly referred to another available one,” he said in a statement.
Pressure from the private sector worries managers
The insufficient increase of the ministry led the sector to address requests to the State Secretariats for integration of the missing amounts. Although the deficit is about 39% in the national average, the real cost of hemodialysis varies between R $ 293 and R $ 321, depending on the state, estimates the ABCT, which makes demands vary locally. While the industry is calling for a redial of R $ 103 per session in São Paulo, the claimed increase is R $ 74 in Paraíba.
“Either the sector opens a national table with the Ministry of Health and we resolve it at the national level, or we will fragment the discussions in all the entities of the federation, which is inappropriate because it disorganizes the SUS”, criticizes the public health doctor Nésio Fernandes. health secretary of the Espirito Santo. He also chairs Conass, the National Council of Health Secretaries.
“Renal replacement therapies are part of a ministry funding line in which, as a rule, there is no co-financing by the states. But the clinics end up putting pressure on states and municipalities because we are the signatories of the agreements”, reflects the orthopedic doctor Eduardo Ribeiro. , Executive Secretary of Health of the State of São Paulo, defending a federal debate on readjustment.
The pressure against the States, however, was unsuccessful. “Governments think that a clinic manager is a millionaire, who is there to make money. On the contrary,” criticizes nephrologist Osvaldo Merege, president of the Brazilian Society of Nephrology.
About 60 percent of dialysis sessions are performed by smaller clinics, according to ABCDT. But the threats of suspension of the service to the SUS by some private networks have been viewed with suspicion by public operators.
CEO Bruno Haddad, CEO of DaVita, denies that the multinational is lobbying for the adjustment to cover lower-than-expected profits. “We have been, very responsibly, alerting the situation for more than six months, in advance and asking for help. We are not threatening to shut down, but by telling managers that there is complete impracticability and asking them to please do something. “, justifies Haddad, who projects a new focus for the company in the care of patients with private plans.
This is because, he says, the group can no longer “subsidize the reality of the SUS”. Of the 91 clinics in the country, 46 have been acquired by DaVita in the past two years, most of them small or medium-sized units that were in financial difficulty.
DaVita has focused its pressure for funds in the State of Sao Paulo, where the network controls about 14% of the dialysis clinics serving the public system and the delay of therapy compared to the SUS table is greater.
According to nephrologist Sérgio Dias, who is currently researching the Brazilian dialysis market in his doctorate at FGV, the sector is undergoing a progressive flattening of profits in recent years, which, in the long term, can demolish the service by hindering investments in new machines and business expansion.
Dias warns, however, that concentration in the hands of a few suppliers can favor the creation of bargaining power in the face of agreements or SUS. “In 2015, a federal law gave space for multinational companies in the sector to participate in the national market. This entry has evolved, as has the concentration in this sector, which can eventually create problems. If there is a cartelization of dialysis, companies they may threaten to suspend treatment for readjustments, “he says.
The funding of the SUS is shared, the ministry says
In a July letter to the Ministry of Health, Conass and Conasems, the National Council of Municipal Health Departments expressed concern about the pressure from the dialysis industry on states and municipalities. For entities, this therapy should have exclusive Union funding.
In a statement, the Ministry of Health said it transfers financial resources to all states and municipalities on a monthly basis to pay for hospital procedures and services, including hemodialysis sessions.
In 2021, the ministry says, R $ 63.1 billion was transferred to state and municipal health funds. In 2022, up to August, it was more than R $ 36.3 billion, he claims. “It is worth mentioning that SUS funding is tripartite, with the participation of states and municipalities,” he adds.
Researched, the Federal District Department of Health did not answer questions, but said they have seven associated hemodialysis clinics, which together offer 1,003 therapy places monthly, plus 475 for peritoneal dialysis.
“It is important to clarify that the secretariat follows the SUS table with values set by the Ministry of Health. Therefore, the Ministry receives the funds from the federal agency and transfers them to the clinics, as agreed in the accreditation notice.”
The Rio Grande do Sul Department of Health has not responded whether it will restore the amounts requested by the sector, but reported that it has 63 dialysis services enabled in the state, 26 of which are private, and that “there are new license applications from the Ministry of Health in progress. ”The file says there are vacancies available for new patients in various services in Rio Grande do Sul.
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Source: Terra
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