A change in the form of remuneration for services provided via the Unified Health System (SUS) could cause a deficit of around R$55 million for the Hospital de Clínicas da Unicamp this year, according to a forecast made this Monday (8) by the director executive of the University's Health Area, Oswaldo Grassiotto.
Because of this concern, the Dean and managers of the Health Area at Unicamp met with a group of 12 state deputies from São Paulo. The event took place in the University Council room, on the Barão Geraldo campus (Campinas).
At the meeting, Unicamp management discussed proposals with parliamentarians to avoid the deficit generated by the new remuneration methodology. Additionally, there was talk about the reorganization of the regional health system, the need to build a regional hospital in Campinas and the adoption of medium and long-term measures to establish an industry in the region around the health complex.
The event was organized by deputies Gilmaci Santos (first vice-president of the Legislative Assembly of the State of São Paulo – Alesp –, Republicans), Barros Munhoz (Brazilian Social Democracy Party, PSDB) and Bruna Furlan (president of the Alesp Health Commission, PSDB). Also present were deputies Ana Perugini (Workers' Party, PT), Andréia Werner (Brazilian Socialist Party, PSB), Clarice Ganen (Podemos), Dirceu Dalben (Citizenship), Oseias de Madureira (Social Democratic Party, PSD), Ricardo França (Podemos) and Valéria Bolsonaro (Liberal Party, PL). Deputies Rafael Zimbaldi (Citizenship) and Rogério Nogueira (PSDB) sent representatives.
According to the rector of Unicamp, Antonio José de Almeida Meirelles, the current management of the University is characterized by maintaining intense contact with Alesp and the state government, “always in an attitude of collaboration for the development of the State”. The rector also said that Unicamp wants to play a central role in organizing the health and assistance structure in the metropolitan region of Campinas and neighboring regions.
For Meirelles, the meeting sought to “discuss future plans” and ways to enhance care across the health sector. “This would involve improving primary and secondary care, with the implementation of a regional hospital and UPAs [Emergency Care Units], allowing patients to enter the HC only via referral,” stated the rector.
“This would allow the HC to concentrate on what is most characteristic of its function, highly complex procedures, currently carried out on a smaller scale than possible due to the need for urgent care”, he argues. “We want this emergency care to be provided in other structures, in which we also participate, but in a way that allows a sequential, hierarchical organization of health care”, reinforced Meirelles.
The parliamentarians received information about the Unicamp health complex, comprised of the University Hospital in Campinas and the facilities of the Women's Hospital Caism Unicamp, the Hemocenter, the Gastrocenter, and the Faculty of Medical Sciences, as well as the Sumaré State Hospital and the Piracicaba Regional Hospital. The complex also includes AMEs (Specialized Medical Clinics) in seven cities in the region. In total, the University's health facilities serve a region where approximately 7 million people live.
Resource transfer
According to Grassiotto, the new remuneration system established by the so-called SUS Paulista this year stopped paying for the ceiling and started transferring resources based on the number of procedures actually performed.
The director of the Health Area Executive Board (Deas) says that, previously, the HC could carry out 80%, 90% or 110% of the procedures, but received a ceiling of 100%. “And this happened because it was necessary to define an average [of service volume] so that the hospital would not be permanently hiring and firing employees, according to demands”, he explains.
The problem, says Grassiotto, is that HC is an open-door hospital, in which emergency cases take up 60% of the beds. These cases, however, are low-paying and often involve long-term hospitalization. “By staying in hospital for a long time, this patient prevents you from carrying out the highly complex procedures that are the primary function of the hospital”, he says. For him, the HC is being penalized for providing emergency care. Because of this, he assesses, it is necessary to build a regional hospital, precisely to provide this type of care.
While the construction of this regional hospital does not take place, Grassiotto suggests that a minimum care infrastructure be set up, either through the opening of UPAs or through the use of small regional hospitals with idle beds, which, he argues, could provide care for urgency.
Alesp Commission
At Dalben's suggestion, a commission of state deputies and representatives of the Unicamp health sector was created with the aim of starting negotiations with the State government, in addition to seeking greater speed in the investment approval processes for the sector. It was also decided that in the coming weeks the director of Deas should speak to parliamentarians who are part of the Alesp Health Commission.
The general coordinator of Unicamp, Maria Luiza Moretti, called the meeting with the deputies “historic”. “We are at a point where, to advance the services we provide to society, we need your help,” she said, addressing parliamentarians.
Also participating in the meeting were the director of the Faculty of Medical Sciences, Claudio Coy, the teaching advisor of Deas Angela Maria Bacha and directors of health units, hospitals and AMEs administered by Unicamp, in Campinas and the region.
