As ICUs Fill, Pressure Builds for Government Control Over Private Beds

RIO DE JANEIRO, BRAZIL – Healthcare institutions want the public sector to have access to private health plan beds for hospitalization of patients infected with the coronavirus. They are at the forefront of the ‘Leitos Para Todos’ (Beds For All) movement.

The concern is that the public system will become overburdened, while the private health care system only serves its beneficiaries. According to the movement, the Single Health System (SUS) has 44 percent of the total number of ICU beds available in the country; while 55 percent of the existing beds are geared toward serving health plan beneficiaries, who make up approximately 25 percent of the population.

In a document published on Wednesday, April 22nd, the National Health Council recommends that the Ministry of Health and the state and municipal health secretariats coordinate “the allocation of existing assistance resources, including hospital beds owned by private institutions, requisitioning their use whenever necessary, and regulating access according to the health priorities of each case.”

In Amazonas state, the ICU bed occupation rate is already over 90 percent. In Ceará, it has already reached 100 percent. In the state of São Paulo, the ICU occupation rate is 53.4 percent, but in the state capital it is 73.3 percent. Meanwhile, according to the National Health Council, private hospitals are emptier, with some “having even requested authorization from the National Supplementary Health Agency (ANS) to resume elective surgeries”.

According to Francisco Campos Braga Neto, coordinator of the Policy and Hospital Management Observatory at Fiocruz, integration between the public system and the supplementary health system is needed. “It is a pressing and urgent measure. The projections show that the collapse of the health system is knocking on our doors,” he says.

The use of private sector beds was even suggested by Luiz Henrique Mandetta, the former Minister of Health; however, the issue has not yet been decided by the federal government. “It’s worth emphasizing that there have been important contributions, we cannot deny that an effort is being made, but this needs to be done to a greater extent. And this intensified collaboration involves a call from the state,” says Braga Neto.

Among the institutions involved in the movement are the Brazilian Association of Collective Health (ABRASCO), the Brazilian Association of Teaching and Research and Social Service (ABEPSS), the São Paulo Association of Public Health (APSS), as well as labor unions and social movements. A group of lawyers initiated a similar movement, called ‘Vidas Iguais’ (Equal Lives).

“In addition to insufficient beds, we are in danger of the care for coronavirus patients replicating a disturbing structural mark of the Brazilian health system: inequality,” reads the movement’s document.

In late March, the PSOL (Socialism and Liberty Party) appealed to the Federal Supreme Court (STF) for regulation by the government of the use of intensive care unit (ICU) beds in the private network during the novel coronavirus pandemic. The petition was rejected by the rapporteur of the case, Justice Ricardo Lewandowski.

According to the rapporteur, there are already rules that make it possible for the public power to requisition health goods and services, and the Judiciary’s action in this respect disregards the principle of separation of Powers.

The issue has also been discussed in the Legislative branch of government. Deputy Arlindo Chinaglia (PT-SP) submitted a bill calling for the unification of the state list of cases with indication for hospitalization. In Minas Gerais, governor Romeu Zema (NOVO) sanctioned a bill that provides that when there are no beds available in public or private hospitals accredited by the SUS, the health facility manager may requisition admission to hospitals in the private network for Covid-19 patients.

In São Paulo, a bill proposed by state deputy Isa Penna (PSOL) intends to establish that ICUs in the private network should be considered of public utility while the health crisis persists.

However, the issue generates controversy among organizations representing the private sector. In a note, the National Association of Private Hospitals states that, with no planning, the measure “will have adverse consequences, harmful to the system as a whole, since private hospitals will be forced to deal with multiple requisitions of their ICU beds”.

The organization states that recently, private hospital supplies and Individual Protection Equipment (IPEs) were confiscated by a number of Brazilian states and municipalities, compromising the protection of health professionals and the care for patients infected by Covid-19.

The National Supplementary Health Federation, which represents 16 private health insurance providers, says such measures will lead to disputes over beds. “The adoption of a single line will only lead to a dispute over beds, in which those who rely exclusively on the SUS will also have to compete with those who have health plans”.

“We fail to see how a proposal of this nature could help in the fight against the pandemic, and it is certain that the vacancies in the private system also tend to become depleted in the near future,” the organization says in a note.

Source: Exame