Investment in primary care, integration of state and municipal services, digital health and technological development were the main topics discussed during a seminar promoted by the Sheet last Tuesday (20) with the representatives of the three candidates for the Government of São Paulo best placed in the polls.
Sponsored by Sindhosp (Union of Hospitals, Clinics and Laboratories of the State of São Paulo) and Janssen, the event brought together the campaigns of Fernando Haddad (PT), Tarcísio de Freitas (Republicans) and Rodrigo Garcia (PSDB) to present proposals for improve health management. The mediation was performed by Cláudia Collucci, a special reporter for Sheet.
In the first half of this year, about 538,000 patients were waiting for elective surgeries in the state network, according to the São Paulo Health Department, a scenario aggravated by the damming of procedures during the pandemic.
To reduce queues and expand access, Haddad intends to unite state services with primary care in municipalities and expand the Hora Certa Network to the entire state, made up of hospitals that concentrate the offer of specialists, exams and simple surgeries, says the ex- Minister of Health Alexandre Padilha, PT representative.
The project was implemented by Haddad in São Paulo during the period he was mayor (2013-2016).
Watch the full debate:
“Facing the challenge of access and reducing waiting time requires the expansion and strengthening of primary care and integration with specialized care networks. This cannot be done without the State Health Department coordinating the process”.
For David Uip, São Paulo’s Secretary of Science, Research and Development and a representative of Tucano, the functions of the Hora Certa Network are equivalent to the role of the 62 AMEs (Medical Specialty Outpatient Clinics) that already exist in the state, which are also responsible for offering access to specialists, exams and, in the case of AME Mais, minor surgeries. Garcia’s plan is to have more AMEs aimed at cancer patients, women and the elderly.
“The AME is the greatest example of Day Hospital, because it supports primary care, offers specialties and precedes hospitalization. At AME Mais, surgical procedures and invasive diagnoses are performed that do not require an overnight stay”, says Uip.
Padilha disagrees with Uip and says that the state system is fragmented, as it does not dialogue with the municipal, university hospitals and Santas Casas. According to the former minister and federal deputy candidate for reelection, the integration of these services would optimize resources and could occur with the adoption of digital health.
Tarcísio’s proposal is that, through telehealth, primary care reduces the burden in medium and high complexities and in urgencies and emergencies, says Eleuses Paiva, former president of the AMB (Brazilian Medical Association) and representative of the former minister of Infrastructure of the Jair Bolsonaro government (PL).
Primary care belongs to the municipality, but it impacts the state if it is not resolute. The partnership between state and municipalities to computerize and implement digital health is necessary
Like Padilha, he sees the integration with primary care as an alternative to improve access and ensure that patients are seen in a timely manner. Working together with the federal government, Tarcísio wants to review pay tables.
“The philanthropic ones are close to bankruptcy. If we don’t act in the next few months, we may have a collapse in service”, he says.
When asked about health financing, Haddad and Tarcísio’s campaigns committed to investing at least 12% of revenue, as required by law, and eventually increasing this rate, without citing exact numbers.
Uip points out that the state pays most of the nearly R$30 billion in the budget that São Paulo allocates to the area, since only R$6 billion comes from the Union. The secretary says that, in order to increase the quality and productivity of the system and overcome the lag in the SUS table, the current governor, if re-elected, wants to sign more contracts with social health organizations.
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Resorting to public-private partnerships is a common point in campaigns for technological development and innovation. According to Uip, this is already happening when national and international industries join the Butantan Institute to transfer vaccine and drug production technologies.
Setting up an economic and industrial complex is among the plans, says Padilha, to increase the production capacity of medicines, reduce dependence on external inputs and encourage the permanence of industries.
The SUS is not sustainable if we do not increase the capacity to produce medicines and technologies. São Paulo can do this because of its strength in the industry, whether from national origin or from international partners.
Along the same lines, Paiva states that there would be an incentive to technological development by establishing partnerships with the private sector and the federal government to finance universities, research centers and industries.
Cited as a key piece by the three campaigns to improve access, digital health would be implemented with actions between secretariats and public-private partnerships for logistics, for example, in an eventual PT government. For Padilha, the São Paulo network can be fully connected in four years.
In Tarcísio’s administration, telehealth would be used to increase the efficiency of services in distant regions, with access to specialties.
For Uip, digital health offers the possibility of a second opinion in the face of a clinical condition and is a means of qualifying the professional who cares for the patient in the municipalities. He says that digitization is already a concern of Rodrigo’s management.