a covid-19 pandemic The rising dollar also hampered heart surgeries at SUS. The scarcity of resources for elective procedures is a chronic problem, but it has now worsened.
Medical entities and hospital administrators have reported that they are suspending operations because they cannot purchase supplies such as valves, cannulas and oxygen. The SBCCV (Brazilian Society of Cardiovascular Surgery) estimates that about 50,000 people wait in line for operations of this type, and the number of visits is declining each year.
NS US currency snapshotSupplies are becoming more expensive, reaching values much higher than what the federal government carries to hospitals.
For this reason, there are states where surgeries have been halted, such as Goiás, while others have decided to allocate their own resources to continue carrying out the procedures.
The situation is more serious in cardiovascular surgery with cardiopulmonary bypass. These are very complex heart operations in which the doctor needs to open the patient’s chest.
In 2020, 31,931 such surgeries were performed, 22.9% less than in 2019, according to data from the Ministry of Health organized by SBCCV.
The Department of Health states that it is up to states and municipalities to manage waiting lists. He also states that he is conducting studies to evaluate possible adjustments in the amounts transferred for these procedures.
Eduardo Rocha, president of SBCCV, says this waiting list was created for two reasons. The first is the epidemic that has caused very complex surgeries to be performed. with the shortage of intensive care beds and vacancies in hospitals, They had to be commented.
“Instead of opening the patient’s chest in the face of the epidemic, we chose to do less invasive procedures, which are worse in the long run. We did this to keep patients alive and not spend a lot of time in the hospital and the intensive care unit,” he says.
Another reason is the lack of products to perform these surgeries. There are suppliers who are not willing to sell to SUS because of the table value paid. Hospitals in nine states reported problems to SBCCV.
The “SUS Schedule,” which records the amount the federal government paid for various actions in the SUS, is outdated. For cardiovascular surgeries with cardiopulmonary bypass, which require valves, cannulas, and oxygen devices, there has been no modification since 2002.
In 2021, with the rising dollar and inflation, the situation has become unsustainable, according to the directors of SUS and medical entities.
Of the five companies that supply these products to SUS, three have stopped providing them, says Paulo Fracaro, supervisor of Abimo (the Brazilian Association of the Medical Device Industry). He says he is in contact with the Ministry of Health to try to solve the problem.
“With the decrease in the epidemic, the number of surgeries using valves and oxygen devices increases, and the demand for inputs also increases. Companies are unable to meet this demand or else the loss will increase. The price of raw materials, electricity, wages rise, workers with imported products, the dollar rises.”
Truck driver Jesús Garces Bueno, 52, has been waiting in line for four months in Annapolis (GO) for coronary artery bypass graft surgery. He suffered from heart attacks that made it impossible for him to even work.
After receiving no response from public agencies regarding the date of the surgery, Bueno sought justice, who ordered the operation to be performed within 15 days.
“The medical report says I’m in danger of life and even if they don’t schedule the surgery, I think God is still keeping me alive. Every time I go to town hall they say SUS is not subject to any input and they don’t have money to cover the surgery,” regrets.
The president of Braile Biomédica, Patrícia Braile, appreciates that it is increasingly difficult to provide products for cardiac surgery in SUS. She explained that the price of the set used in surgery with cardiopulmonary bypass is R$1,581.63 by SUS since 2002, that is, it has been for 19 years without adjustment.
“There is a risk of shortages. Many of the inputs and raw materials are imported from the US and Europe and the values are in euros and dollars, which increases costs a lot,” he notes.
Bruno Botelho Pinheiro, a cardiovascular surgeon and SBCCV member, says that in Goiás cardiovascular surgeries performed by SUS have been reduced due to a lack of supplies. Some hospitals have even paid teams so that they can continue operations. But each site deals differently.
“It has been completely discontinued in Annapolis since March 30, although 70 are already licensed,” he says. “Some hospitals in Goiania are already supplementing the value in more complex cases.”
The CMB (Confederation of Santas Casas de Misericórdia, Hospitals and Charitable Entities) is alerting the Ministry of Health in June about difficulties in performing surgeries.
In the document, the entity states that the industry’s adjustments increase the difference between the amount the federal government pays and the amount recorded in the entry bids.
Cristiano Dekel, CEO of Bruno Born Charitable Hospital, in Lajedo (RS), says he has had to seek help from the city and even send patients to other units due to rising costs in recent weeks.
As an example, Dickell cites the government sending R$1,500 to purchase biological valves, but the product costs R$3,700. The Lajeado unit is a reference in the region, serving patients from 37 cities. The increase started last month. Suppliers say the problem will only get worse.
Cardiovascular surgeon Silvana Berwanger, MD, of Santa Casa de Igua (RS), stated that it was unprecedented to interrupt surgeries due to a lack of supply options. The unit in which she operates has eliminated elective operations, and has retained a set of biological valves intended for emergency surgery.
The Ministry of Health, in a memorandum, sought that the SUS schedule contain five special actions related to the substance in question, the cost of which is funded by resources from Vol.
However, the responsibility rests with the local director for planning and managing federal transfers, the health institution, and the acquisition and management of prosthetics and materials, the ministry said.
“The value of the biological valve prosthesis in the SUS schedule was adjusted by 63% in 2017. In order to obtain additional and complementary benefits, given the high degree of complexity of the situation, the Ministry of Health is conducting an economic study to assess the possibility of a “re-settlement of the sums paid by the Union for Prosthetics and extracorporeal circulation devices.
The Goiás government stated, in a note, that the units performing highly complex cardiac surgery are located in Goiania. Referral is the responsibility of the Goiania Municipal Health Department. The city council of Goiânia and Anápolis did not respond to the article’s questions.
Kunas (National Council of Health Ministers), in a statement, said that he had presented to the ministry and in discussions with SUS managers his “concern over performing elective surgeries, especially due to the Covid-19 epidemic.”
“Mortality and morbidity from cardiovascular disease require integrated actions to occur rapidly,” Entity assessment.
For Diego Xavier, a researcher at the Vuecruz Institute for Scientific and Technological Communication and Information in Health, in addition to evaluating a 22% reduction in cardiac surgeries, it is important to note whether there is an increase in deaths in the pandemic from Cardiovascular problems.
“Now that we will resume We have the responsibility left behind and current demands. He concludes that many people will end up having problems because if there is less action, more people will die because they did not receive help in time.”
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