PLANOS DE SAÚDE TERÃO DE INCLUIR NOVAS TECNOLOGIAS
Operadoras estimam impacto de R$ 5,3 bilhões com 16 novos procedimentos na lista de cobertura obrigatória
A incorporação de 16 das 26 novas tecnologias, em estudo pela Agência Nacional de Saúde (ANS), no rol de procedimentos mínimos obrigatório de cobertura dos planos de saúde, a partir de 2018, tem um impacto estimado em R$ 5,37 bilhões na despesa assistencial da saúde suplementar. Segundo o estudo feito pela Federação Nacional de Saúde Suplementar (FenaSaúde), isso representa um acréscimo de 4% em relação ao custo do ano passado, quando chegou a R$ 135,5 bilhões. Um aumento de custo per capita de R$ 111,37.
No escopo das tecnologias há desde um exame que pesquisa toxoplasmose no líquido aminiótico, com custo por procedimento de R$ 427, ao medicamento oral Criozotine, indicado para o tratamento de câncer de pulmão, que tem um custo anual por paciente de R$ 468 mil.
Essa é a primeira vez que a FenaSaúde faz essa análise. O cálculo se concentrou nos procedimentos para os quais haviam dados suficientes, como o número de pessoas estimadas para o uso daquela tecnologia, explica Vera Queiroz Sampaio, gerente de Regulação de Saúde da federação:
— O estudo foi uma demanda das empresas. O rol é liberado muito em cima do início da vigência e as operadoras precisam preparar a rede, saber quanto custa, qual é a capacidade de atendimento. Levamos em consideração o uso de novas tecnologias por toda a população elegível em 12 meses.
Segundo a presidente da FenaSaúde, Solange Beatriz Palheiro Mendes, esse tipo de estudo só foi feito pela ANS na elaboração do primeiro rol, em 2001. Solange avalia que falta informação no processo e destaca que é importante que o beneficiário conheça o custo dessas incorporações:
— O objetivo do estudo não é dizer se deve ou não incorporar uma tecnologia, mas informar para uma tomada de decisão. Diferentemente do SUS, na saúde suplementar não há critérios de priorização para incorporação de tecnologia. Tem um remédio novo para hepatite C que tem um custo anual de R$ 700 mil por paciente, mas o SUS está usando porque ele cura a doença. Mas há outras drogas que ainda precisam ter seus resultados monitorados.
Professora da UFRJ, Ligia Bahia se incomoda, no entanto, que as contas apresentadas pelos planos de saúde não levem em conta a economia que a incorporação de novas tecnologias traz.
— As novas tecnologias trazem economia, com a cura mais rápida, menor uso de terapia intensiva, redução de complicações. O cálculo tem que trazer esses ganhos. Além disso, é preciso levar em consideração que toda tecnologia tem uma curva de custo: começa alta, mas com a disseminação vai caindo — diz Ligia, membro da Comissão de Política, Planejamento e Gestão em Saúde da Associação Brasileira de Saúde Coletiva.
A gerente de Regulação da FenaSaúde afirma que apenas em dois dos casos estudados as novas tecnologias substituem as anteriores. As demais se somam as já existentes.
Na avaliação do médico Márcio Mereilles, editor executivo do portal Observatório da Saúde, a discussão será infrutífera enquanto o foco for o lucro:
— Neste sistema todos estão preocupados com lucro, operadoras, médicos, hospitais e laboratórios. E tem que ser assim para que as empresas não quebrem. Mas enquanto o paciente não estiver no foco a avaliação será equivocada.
Consultada a ANS informou que está analisando as contribuições enviadas à consulta pública sobre a atualização do rol, encerrada no último dia 26, e que ainda não há definição sobre os procedimentos que serão incorporados.
fonte: https://oglobo.globo.com/economia/defesa-do-consumidor
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