The AC Camargo hospital, with almost 70 years of tradition in the treatment of cancer in São Paulo, will stop serving SUS patients as of December, which should worsen access to these therapies in the capital of São Paulo.
Currently, more than 3,000 people in the state are waiting for vacancies in Cacons (High Complexity Assistance Centers in Oncology), regulated by the Cross platform (Center for Regulation of Health Services).
The main reason for the end of public care, according to the institution, is the delay in the SUS table for consultations, procedures and surgeries, which means that every year the hospital has to provide its own resources to cover the gap. Other areas, such as dialysis, face a similar crisis.
In 2021, for example, SUS revenue was BRL 36 million and AC Camargo had to inject another BRL 98.46 million, coming from private care, to close the bills. The institution’s net revenue in 2021 was BRL 1.32 billion.
Opened on April 23, 1953, AC Camargo was the first hospital in the capital built with donations from the population. It was not linked to any official health institution, had no financial support from religious organizations, nor was it sponsorship from immigrant colonies, as was usual at the time. Over time, it has also become an international reference in cancer teaching and research.
The institution, maintained by the Antônio Prudente Foundation, which bears the name of its founder, communicated the decision to the Municipal Health Department earlier this year, with whom it has a contract until December 9 this year. The resources come from the Ministry of Health directly to the municipality, which transfers them to the hospital.
In a note, the Municipal Health Department said that it was informed by the foundation about the non-renewal of the contract and says that it has held meetings to assess the possibility of continuing care through the partnership.
Management emphasizes, however, that oncology care for patients in the municipal network will continue to be offered through other municipal service providers, such as Hospital Municipal Dr. Gilson de Cássia Marques Carvalho–Vila Santa Catarina, and other units regulated through the State government’s Cross (Health Services Supply Regulation Center).
Asked about the lack of readjustments to the SUS table, the Ministry of Health says that “the table is not the main nor the only way of financing the SUS” and that “the values are minimum references, and can be complemented by state and municipal managers , according to the demands and needs of each territory”.
About 1,500 of the 6,500 SUS patients monitored by AC Camargo have already been transferred by municipal management to cancer centers in the capital. Another 5,000 are expected to be referred by December, according to the hospital.
In recent years, the institution had been reducing the number of new patients seen by the SUS. In 2017, for example, there were 1,500. In 2022, only 96. Already through the private door, almost 7,000 new patients entered this year. In total, about 230,000 are served annually.
Until 2017, AC Camargo had a five-year contract with the city of São Paulo (Cebas, certification of charitable social assistance entities), which provided that 60% of its services would be dedicated to the SUS.
According to Victor Piana de Andrade, CEO of ACCamargo Cancer Center, with the increasing lag of the SUS table and the increase in demand for health plans, in 2018 the institution opted for a new contract model, which allowed it to adjust annually the percentage of SUS care according to private demand. The agreement was approved by the Public Prosecutor’s Office, but even then the accounts were not closed.
“I have the responsibility to manage resources well, to ensure the balance of accounts. Oncology is expensive, medical inflation is higher than common inflation and, with the SUS table fixed for 14 years, and with the rising costs, I cannot bring that risk to the institution.”
He cites an example of the lag. The SUS pays R$ 10 for a medical consultation, while the insurance companies, on average, R$ 100. The values of chemotherapy and radiotherapy sessions reimbursed by the SUS are 94% and 71%, respectively, lower than those paid by health plans.
According to Andrade, the foundation’s mission is to improve oncology in Brazil and this is not limited to public services. “If I have a high volume of private care and I use that to train 130 professionals every year, I’m doing it very public. When I have research that makes treatment cheaper, that’s very public.”
He says that the hospital tried several alternatives before deciding to end the care. He tried, for example, to be part of Proadi, a federal government program to support the development of the SUS, which has among its partners the Albert Einstein and Sírio-Libanês hospitals.
“We got a technical yes [do Ministério da Saúde] and a no of political decision. We tried a couple more times, we had very interesting projects, but we couldn’t. We understand that door was closed.”
According to Andrade, due to a lack of investment in cancer prevention and early diagnosis, the public sector currently manages lines of advanced cancer patients. “We are left with an adverse selection. We take care of advanced and complex patients. And the success rate is lower. It’s very frustrating.”
The hospital also faced another challenge with SUS patients. Due to the bond created with the institution or the lack of access to other health services, they ended up looking for AC Camargo for other health problems not related to cancer. “If he falls on a motorcycle, he wants to rehabilitate here. If he is diabetic, he wants to be treated here.”
According to the Atlas of Cancer Care Centers, from the Oncoguia Institute, 53% of public resources received by AC Camargo in 2021 went to oncology. The rest, according to the hospital, was to address other health issues of the cancer patient.
“If the patient has already finished the cancer treatment, he should have been referred to the UBS near his house for follow-up. We should have always done this, but we didn’t. We spent 70 years hugging like a mother”, says Andrade.
The hospital even proposed to the city hall of São Paulo to become the oncological reference in the city, only treating cases of high complexity. For example, it would operate on patients already linked to other public hospitals and then they would continue to be followed in these institutions. But it was also unsuccessful. Currently, there are talks with the state government about possible partnerships.
At the same time, the institution is developing a national project, called the AC Camargo mission, which will involve the public authorities and the private sector in prevention, diagnosis, treatment and rehabilitation actions, in addition to training primary care professionals and hospitals to provide care of cancer.
“We are repositioning our social responsibility to gain a larger geography and a larger population. We want to use our influence, our credibility and also our resources to build a cancer care ecosystem.”
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