SUS queues will not end – 06/08/2023 – Rodrigo Zeidan

Is it possible to end queues in the health system? Not sustainably. And that’s okay. This is the cost of designing a universal healthcare system, whether in Brazil, England, or anywhere else. Queues are a natural consequence where prices are not flexible to balance supply and demand. The problem is not the existence of queues per se, but the fact that there is no predictability regarding size or rationality in prioritizing procedures.

Lula will not be able to end the SUS queue of one million elective surgeries stopped in the country. But she has the opportunity to rationalize it, copying what she can from the rest of the world.

Let’s take the example of Denmark. There, the rule is simple. If the health system cannot guarantee that the treatment (or appointment) defined as relevant will start within 30 days, the patient has the right of “free choice”, being able to resort to a private hospital in Denmark or abroad. That sounds great, but it doesn’t solve the problem. Many poor quality treatments are done just to reset the 30 day period. In addition, there is pressure for treatments to be classified as elective. And finally, it’s rare to get an appointment in less than two weeks; in most of the system, scheduling is close to 25 days.

A few anecdotes, but informative. A colleague needed an appointment with an ophthalmologist, making the request as if it were something relevant. He got there and was scolded by the doctor, who said young people should never make that kind of appointment unless they were close to going blind. The priority would be the elderly. Another case, more serious. A former student was in a car accident. He complained of back pain, but they didn’t recommend him for an MRI, as the machine was expensive and there was a queue of priorities. But he had broken his spine and was barely a quadriplegic. Even after discovering the seriousness of the problem, they didn’t want to operate. He spent two years in physical therapy (including in Spain, when they didn’t fit him into the public system within 30 days), with no result. Finally, they approved the surgery (out of a panel of three surgeons, two need to approve “elective” surgeries in order for them to be scheduled).

Does this mean that single health systems are bad? No way. The Danish (or English or Canadian) system is good, though not perfect. No health care system is. In capitalist China, without a universal system, the onset of covid could have been contained if everyone had sought care. But as most have some subsidy, but need to pay something out of pocket if they use the public system, many preferred not to seek the system so as not to spend money (the tests, in the beginning, were not free either). The US, less capitalist, created a caste system: the oldest have almost universal care, via Medicare and Medicaid, while the others found themselves in the private market (also with subsidies). Another model is the German one, where everyone is required to pay private insurance. Health systems are complex and are never perfect. Reality is harsh. But that doesn’t mean they can’t be improved. SUS is life. But it can get even better if managed well. This government might as well focus on that instead of transferring money from the poor to the rich via car subsidies. Who knows, maybe one day we’ll leave the 20th century?

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