Analysis: Presidential campaigns lack clear goals to increase health financing

Health is the topic that most concerns Brazilians, but the campaigns of presidential candidates best placed in electoral polls do not inform objective goals to face one of the main problems in the area, the underfunding of the SUS.

Public spending on health is around 3.8% of GDP, and corresponds to half the average of the OECD (Organization for Economic Development Cooperation) member countries. Private spending, especially those of families with health plans and medicines, reached 6.2%.

In a cycle of hearings held by Folha, Lula’s campaign (PT) guaranteed that there will be an increase in public spending, with the objective of making them higher than private spending, but did not define a percentage of GDP or a deadline to reach it. Bolsonaro’s campaign, on the other hand, did not participate in the debates and also did not respond to the questions sent.

Ciro Gomes’ (PDT) campaign is committed to raising public spending on health to 6% of GDP, the same goal set out in a pact signed in 2014 between Brazil and other countries and PAHO (Pan American Health Organization). Simone Tebet (MDB) promises to reach 5% in the next four years and 6% by 2030.

Still as a source of funding, the campaigns of Lula and Ciro committed to revoking the spending cap (Constitutional Amendment 95, of 2016), which established that, for a period of 20 years, health resources would be corrected only by the IPCA (Constitutional Amendment 95, 2016). Broad National Consumer Price Index) of the previous year. This freeze has already withdrawn almost R$ 37 billion from SUS between 2018 and 2022, compared to the previous rule.

Tebet defends that the extra resources directed to health during the pandemic be maintained for up to two years to account for the damming of elective surgeries and procedures, which exceed 900 thousand, according to Fiocruz estimates. Both initiatives, however, depend on the approval of the Legislature.

In favor of a tax reform, Tebet and Ciro promise to increase taxes on products that can be harmful to health, such as ultra-processed foods and alcoholic beverages, measures that are part of public policies recommended by the WHO (World Health Organization) and other international bodies. Lula’s campaign says that the issue will be studied by the economic team.

The presidential candidates also agree on the need to improve the efficiency of the SUS through better qualified primary care that is connected to other levels of health care, such as outpatient clinics and hospitals, which would work in regional networks.

One of the main tools is the digitization of health data, which would enable the long-awaited electronic medical record of the patient, and the use of telemedicine, which would speed up access to specialist doctors, another major bottleneck of the SUS.

However, for this to occur, it will be necessary to ensure that all UBSs have adequate access to the internet. Fiocruz research carried out in 2020 showed that although the number of UBSs with internet has increased, only 40% of professionals report that they have a good connection that allows, for example, a teleconsultation.

An interconnection between the various information systems existing in the municipal, state and Ministry of Health departments is also necessary.

This would even facilitate the creation of a new compensation logic based on results and not just on the volume of procedures, as is currently the case.

To face the lack of doctors, Lula’s campaign also proposes the re-edition of the Mais Médicos Program, which would be renamed, to eliminate areas where there are gaps in healthcare. The idea is not to resort to Cuban doctors, as in the previous version, but to attract Brazilian professionals, through medical residency, offering better working conditions in the SUS.

The challenge is great. Starting with the fact that there is a lot of medical work available in the private sector, which has more competitive salaries than those in the public network.

One of the ideas discussed by Lula’s campaign is the creation of a federal medical career. But a doctor alone doesn’t make a summer. In remote regions there is also a lack of nurses, physiotherapists, dentists, among other health professionals. A broad review of the SUS human resources policy would be needed, involving training and qualification, a topic that still needs more attention in the government plans of presidential candidates.

Candidate representatives also advocate the promotion of major national campaigns to increase vaccination coverage and prevent the return of eradicated diseases. Only 67% of children were vaccinated against polio in 2021, compared to a target of 95%.

Among the strategies announced are the offer of vaccines within schools, the requirement of the vaccination booklet for school enrollment and in income transfer programs, in addition to expanding the opening hours of the UBS. All are valid, but it is necessary to adapt them according to the reality of each region.

The presidential candidates are aware that new epidemics will come and that the country needs to be better prepared to fight them, with its health and epidemiological surveillance systems strengthened, but, again, there is a lack of consistent projects to combat them. The one that advances the most in this regard is Simone Tebet’s campaign, which proposes to transform the Health Surveillance Secretariat into an agency along the lines of Anvisa (National Health Surveillance Agency).

Recognized as one of the best in the world, Anvisa records a decline in the number of servers and this year reached the lowest level since 2010.

The INPI (National Institute of Industrial Property) and the ANS (National Supplementary Health Agency) are also experiencing a similar situation.

Lula’s campaign says it will open public tenders to replace these cadres.

Strengthening the structure of these institutions is also important for strengthening the health industrial complex. Currently, 95% of pharmaceutical ingredients consumed in Brazil come from abroad, from China and India. With the Covid pandemic, which increased the consumption of medicines, the increase in the dollar and the war between Russia and Ukraine, the country began to face a shortage of medicines and other products.

The subject, which also involves research and innovation, goes beyond the limits of health. It also depends on other ministries, such as Economy, Science and Technology and Justice. Ciro Gomes’ campaign proposes to leave it in charge of the Civil House and make it an inter-ministerial issue, a state policy.