In another action of the now there are experts, a federal program that tries to reduce long waiting lines of SUS, the federal government announced on Monday, 28, that patients who are waiting for some specialized procedure in the public system to be treated by health plans for free.
The idea is for operators to offer SUS patients surgeries, examinations and consultations with experts in exchange for their debt with the Ministry of Health.
The ordinance that regulates the action was signed on Monday afternoon by the Minister of Health, Alexandre Padilha, and by the Minister of the General Advocacy of the Union (AGU), Jorge Messias.
According to the folder, the goal for this year is that R $ 750 million due by the operators will be converted into more care. This represents about 58% of the amount of R $ 1.3 billion that health plans should currently be reimbursed to the Federal Government for having their customers assisted in the public network.
According to Padilha, although this reimbursement is mandatory, the receipt of these values is time consuming and cannot always be used to fund the ministry’s priority actions.
“Debts, by law, have to be reimbursed to the National Health Fund. We have a hard time recovering these debts and, even when they come back, they do not mean more care because you have rules for limiting investments in health. We are turning these debts into more surgeries, more experts, more specialized consultations and less waiting time for those waiting,” said the minister, during a press conference.
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According to the ministry, three days after the publication of the ordinance, a notice will be opened for voluntary adhesion of operators who want to participate in the program.
They will have to prove technical and operational capacity and offer the program’s list procedures now has specialists, which prioritizes six medical specialties with greater demand: Oncology, Ophthalmology, Orthopedics, Otorhinolaryngology, Cardiology and Gynecology. “It will also be considered the demand of states and municipalities, which will present their needs,” said the federal agency, in a statement.
The ministry promises that SUS patients can be treated in health insurance networks as early as August, but some steps will still be needed before the initiative is materialized. According to the folder, after the publication of the notice, the operators will have to request the adhesion via Investsus platform and fill out an offer matrix, with the number and types of procedures they can offer.
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Then, this matrix is analyzed by the Ministry, sent to the states and municipalities, analyzed and approved by the Bipartite Intergeners Commission (CIB) and, only after that, the territorial distribution of the services provided and the contractualization with the operators formalized.
According to Padilha, the procedures offered by medical agreements will be available to the municipal and state health secretariats so that local managers refer their patients.
Thus, SUS users do not need to make any registration or should look for a health plan directly. These are the SUS units of reference that will inform the patient where he will be treated.
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The ministry also informed that the service to be provided by the operators should be distributed so as not to be concentrated in large centers or only some regions of the country.
He also said that to avoid exaggerated spraying of services provided, participating operators must offer care that represents a debt expenditure of R $ 100,000 per month, which can be relaxed to R $ 50,000 per month in the case of regions that have fewer health facilities and great demand.
For the ministry, in addition to regularizing the fiscal situation when they have their debts, operators benefit from using the idle capacity of care in agreed hospitals and “reducing administrative and judicial disputes”.
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Sought by Estadão, the Brazilian Association of Health Plans (Abramge) said that “he sees the ordinance with great enthusiasm” and stated that “such a measure represents an important step in building joint solutions between public and private health sectors, promoting greater integration, cooperation and, above all, agility in the access of the population to medium and high complexity procedures”.
“This decision shows a significant evolution in the integration between public and private health systems in Brazil. It is a measure that strengthens our system and, above all, benefits millions of Brazilians who await care in the public network,” said Gustavo Ribeiro, president of Abramge.
The entity also said that “the path to a more sustainable and resolute system necessarily goes through collaborative partnerships and an integrated view of care for the citizen.”
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The National Federation of Supplementary Health (Fenasaúde) was also sought, but did not position itself until the conclusion of this report.
