Financing of the health system, regulation, management, regionalization, public-private relations, information and the entry to the Unified Health System (SUS) are the greatest challenges of the Brazilian health system, as shown by the former president of the Central Bank, Armínio Fraga, at the conference “Health and Medicine: a social economic vision”, held on September 30th at the Theater of the Medical School of USP.

The analyzes on the health system situation and its relations to the economy was followed by the comments of Dr. Dráuzio Varella, Prof. Ligia Bahia, of the Federal University of Rio de Janeiro (UFRJ), and Prof. Mário Scheffer, from the Preventive Medicine Department of FMUSP. The FMUSP director, Prof. Tarcisio Eloy Pessoa de Barros Filho was the moderator of the debate.

It’s undeniable the SUS’ history of success with programs such as the Family Health Strategy, programs for fighting tobacco usage and HIV/AIDs, the vaccination and combat of child mortality, besides popularizing generic medication. Although, many problems are still unresolved and continue to the society, such as infectious, chronic and morbimortality diseases. Some these questions are linked to the external causes, such as violence, dissatisfaction with the health system, judicialisation – which demonstrates the coverage issue -, the inefficiency and the lack of funding, among others.

“Financing is a hot topic also in economics. In a model of social security, it’s paramount the government offers funding; not necessarily the provision of supplies. This leads to the issue of concession, privatization and Social Organizations (OSs). The theme seems interesting and should be studied”, says Armínio.

The only economist in a family of doctors, Fraga confessed he brought more questions to the audience than answers. He pointed out several topics on which economists can help in the solution of typical problems in the Brazilian health system.

“The distributive issue, in which the poor pay proportionally more in every service and commodities, is also reflected in health. Not only because the poor population has a shorter life span, but also because they face more relevant disparities. A social pact, in which the rich finance the poor, is still necessary”, he affirmed.

“It was a very rich discussion. This is a new theme for me and I could take notes on many things and get to know the Medical School of USP up close. To come here inspires and motivates me to embrace this new world in which I’m diving in”, said the economist at the end of the lecture.

“Primary attention and information on health deserve more focus”

Dr. Dráuzio Varella has highlighted the lack of continuity of health policies, especially those which approach disease in old age, and of informational tools for the system’s management. He pointed out the constant changes of ministries and their staffs as a “crime” on health.

“The only area in which technology seems to increase the final cost is in health. However, the information systems in health could optimize management. The SUS has the premises of delivering health to 210 million people, but we don’t know our clients. I think it’s cowardice to compare our health system with those of more advanced countries such as the United Kingdom and the Netherlands, which are small and rich”, he compared.

“We have a lot to celebrate. We have delivered free hemodialysis. What country does that? We have a Family Health Strategy awarded by ONU. The crowding in the emergency units, which the TV shows daily, happens because we don’t agree on the need to improve primary care”, says Dr. Varella

The doctor made a quick survey with the audience, asking who had relatives with diabetes and/or arterial hypertension. Most of the people present raised their hands. “It seems as if I asked who will accept Jesus”, he joked. “Don’t underestimate old age. In Brazil, 90% of the population grow old, poorly and reach old age with some kind of chronical disease. If we don’t control these diseases in primary care, we will continue to fill hospitals with heart attacks, blindness caused by diabetes and other complications of untreated chronical diseases”.