A country’s health system is a complex and delicate gear that needs to be taken care of. In Brazil, these mechanisms are increasingly out of balance in a tension that is a risk for society.
The pandemic had a huge impact on this system, not only because of the demand it has suffered in the last three years, but also because of the extensive changes that private health has been going through that could have an impact on the public system.
Today, 50.3 million Brazilians have health plans. Of this total, 41.4 million (82%) are linked to companies. Thus, only 8.9 million fit into the “individual” or “family” categories. With the dismissal of employees and the cancellation of health benefits, as a result of the domestic and global economic crisis, operators were left with fewer people to dilute the risk.
Revenues earned from payments, that is, monthly fees, have not been sufficient to support the assistance expenses of companies in the sector. There are already six consecutive quarters of operating losses, which is to say that, since April 2021, the health plan business has not been able to pay for itself. A brutal increase in care costs, whether due to procedures dammed up by the pandemic or the inflation of hospital supplies, is behind these difficulties.
In 2022 alone, until September, the accumulated deficit reached R$ 11 billion. In addition, in the third quarter, the loss ratio of assistance plans –which represents how much of what operators collect is passed on to pay providers– reached 93.2%. The fourth quarter results of publicly traded health related companies maintain this trend.
In recent weeks, for example, the operator Hapvida, one of the largest in the country, released a balance sheet with a net loss of BRL 316.7 million, reversing the profit of BRL 200 million achieved in the same period, in 2021. of 30% in a single day, which corresponds to a loss of R$ 12 billion in company value.
In the evaluation of experts, Hapvida’s balance sheet is not an isolated fact and foreshadows poor numbers that should mark the sector in the coming months.
When compared to other professions, medicine remains one of the most profitable. However, most physicians depend on their workforce to support themselves. It’s a myth to think that everyone is rich.
Over the past 20 years, changes have taken place in the medical field. Profits at the practices declined as a result of reduced earnings and increased spending. Competition is greater, both due to the increase in the number of medical schools and the entry of professionals from other countries who revalidate. With the emergence of health insurance companies, the patient willing to pay for a private service practically disappeared and the consumer now has his rights regulated.
Many professionals in the area are feeling the changes in a private health market where the main investors were successful doctors, who in recent years sold hospitals to large economic groups that found health to be a profitable business.
Thus, the scenography of the directors of these hospitals changed from doctors to engineers, economists and investors, who make decisions, often only looking at profit.
Given the influx of non-medical investors and the rise in healthcare costs around the world, the only column on the cost sheet that administrators believe could be reduced is medical compensation. All the changes have contributed to a continuous reduction in doctors’ salaries, accompanied by a greater degree of demand, both in terms of technical and administrative capacity.
Concerned, the National Supplementary Health Commission, headed by the Brazilian Medical Association and the Paulista Medical Association, presented the balance of negotiations with health plan operators regarding medical fees in 2022 and warned that “the scenario in supplementary health remains unchanged and the legislation is the same with Law 13,003/2014, which provides for an annual readjustment, but has never defined exactly what that value would be and many do not respect it”. In order for the pants to close, they tighten the doctors.
To help create the perfect storm, there is an increase in the number of poor quality colleges and health professionals. Poorly prepared professionals increase costs, requesting unnecessary evaluations and tests or performing procedures without indication. Of the recent graduates evaluated by Cremesp (Regional Council of Medicine of the State of São Paulo) in 2016, more than half failed , showing that they did not have basic knowledge of everyday situations of medical care.
Thus, the private system is going through an acute crisis not yet perceived by the majority of Brazilian society, but suffered by health, nursing and medical personnel.
If the private health system continues in this trend, the Unified Health System will begin to receive more of these patients expelled by the crisis that companies in the sector are going through. A thorough overhaul and refurbishment needs to be carried out immediately. We survived a pandemic, we don’t even need to talk about the priority that the healthcare system has in our lives.
*Mauro Tamagno is a Thoracic Surgeon, MBA in health management (FGV).
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