Half of the country’s doctors report experiencing, sometimes or frequently, interference from health plans in the treatment they indicated. He also says he has already suffered pressure not to be hospitalized and to advance the discharge of patients.
The data are from a survey carried out by AMB (Brazilian Medical Association) and APM (Paulista Medicine Association) with 3,043 doctors from all regions of the country between February and March this year. The margin of error is plus or minus two percentage points.
The results of the survey were released this Thursday (31) by the entities.
In a note, Abramge (Brazilian Association of Health Plans) said it defends the autonomy of doctors in the diagnosis and treatment of diseases, which is a fundamental principle of medicine. However, he emphasizes that “the development and improvement of clinical protocols is necessary so that care is homogeneous for patients”.
Data shows that 53% of physicians report experiencing attempts or interference to change the treatments they have prescribed for patients. The situation sometimes occurs for 40.9% of them, and frequently for 12.2%.
The survey also shows that 51.8% reported having had difficulty hospitalizing patients, with 6.7% saying that the situation happens frequently. Still 53.1% claim to suffer or have already suffered pressure to anticipate the discharge of patients. Of these, 13.6% said that the situation is frequent.
There is also information that 80.6% reported having already been restricted from the tests they requested from patients.
“We consider that the data found by the research are very serious. They show the disrespect and violation of the work of doctors, and also the disregard for the health of the beneficiaries of health plans”, says doctor César Eduardo Fernandes, president of AMB.
He points out that the survey showed that the most experienced professionals work with the plans, as 69.8% said they had graduated more than 20 years ago. Of the total number of respondents, 55% said that they had attended health plans for more than 20 years, and 51.7% said they had served five or more operators.
“The research shows that these are not isolated cases or that they happen to younger doctors, but that it is a recurrent practice of the plans and that it should not happen”, says doctor José Luiz do Amaral, president of the APM.
The doctors explain that the entities advise professionals to never accept the pressure of the plans and that they insist on offering the care they consider appropriate, since they are responsible for the patient.
“The doctor is the one who will be held responsible for an inadequate treatment or procedure, so we strongly advise them not to fall under any pressure. But we know that this pressure can occur in a veiled way, with the threat of disqualification of the plan for various reasons, as a readjustment of the network”, says Fernandes.
The research also brings the perception of professionals about the projects that are being processed in Congress to change the Health Plans Law, which has been in force since 1998.
The entities say that one of the points of greatest concern for doctors is what changes the way in which the list of mandatory procedures for health plans will be presented. Currently, the list is exemplary and there is a proposal to make it exhaustive.
Called the List of Health Procedures and Events, the list made by the ANS (National Supplementary Health Agency) establishes the mandatory care coverage to be guaranteed by private plans. The first version was published in 1998 and, since then, it has been updated to incorporate new health technologies.
“With the current law, due to the list of exemplifying procedures, plans are, for example, obliged to perform knee surgery. And it is up to the doctor to decide which type of surgery is the most appropriate. With the change, plans can limit this lists only a few less costly procedures, for example, taking away the doctor’s decision-making power”, says Fernandes.
For Amaral, the influence of health plans on medical decisions and the change in the law can make medical advances even further away from the patient’s needs.
“Medicine and procedures are constantly advancing, but if the doctor does not have the autonomy to determine when to use each treatment, the patient will not have at his disposal what is most suitable for his treatment.”
In a note, Abramge said that the supplementary health system aims at the best care result and the preservation of people’s lives. “Partnership is essential between healthcare providers, including doctors, hospitals, clinics, laboratories and health plans, which are interdependent.”​
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