01/10/2018

Interfarma / Política / Posicionamentos

A new chance to healthcare

INTERFARMA sends suggestions to presidential candidates to improve the management of public health

Since 1990 leading research, development and marketing of medicines, INTERFARMA (Association of Pharmaceutical Industry Research) believes that despite all the difficulties, public health in Brazil can be sorted out. The way to find the best solutions lies in the debate and proposals to improve service management, focusing on expanding access to care and medicines and on the well-being of the population. In search of a better future for the Brazilian health, INTERFARMA summarized in four ideas the most critical and urgent points to improve the SUS and ensure a good management of the sector. The proposals gave rise to a letter, delivered to all presidential candidates and their campaign teams, to encourage dialogue and to contextualize each of these issues. The candidates were also invited to pass scrutiny.

The Letter to the INTERFARMA candidates defends: 1. Continuity and technical support in the management of healthcare; 2. The best use of the country's innovative potential; 3. Broadening access to basic medicines; 4. Efficient public policies to enable access to complex drugs.

According to the association, the SUS has already obtained good results in its first battles, as in the fight against infectious diseases and immunization. However, now the challenges are different, as the population is aging, and with that, the demands for chronic and complex diseases such as diabetes and cancer have grown. In addition, according to INTERFARMA, the race for new technologies mobilizes scientists from all over the world, and although Brazil has a lot of potential to participate and excel in this area, it still has a timid support position. And its best scientists are forced to work abroad.

In order to deal with these issues, INTERFARMA's associates affirm that immediate solutions are not enough. They understand that the success of health in the country depends on well-developed state policies that set medium and long-term goals, thus consistently improving the quality of life of Brazilians. 

Pedro Bernardo highlights the worsening of the situation in the sector.
Photos by: Nelson Toledo/For disclosure purposes

For INTERFARMA interim executive president, Pedro Bernardo, the Brazilian health framework is composed of several meanders that need to be identified and faced. The difficulties, he said, were intensified with the economic crisis that plagues the country.

- Healthcare depends a lot on the economic situation in Brazil. With this dip in the crisis and the fall in GDP, the Ministry of Health, which already had difficulty with budget, has become worse. Those who need basic assistance seek the government and are assisted. So do all those in need of high complexity care, so as the government is on both ends. And we have an extra private healthcare sector, which has raised prices above inflation, making it increasingly difficult for the population to pay their healthcare agreements. And even collective and corporate plans are expensive. That is weighing on companies' budgets," he says.

Pedro also points out that the system has been increasingly pressured by a series of changes in the population profile. The growth of degenerative diseases and the increase in life expectancy make the demand for the health service increase more and more, which requires a more consistent prevention work.

TAXES ON MEDICINES

High tax rates make medicines expensive and hamper access to basic medicines, according to Pedro Bernardo. Among the high-priced products, taxation is even heavier. Pedro explains that there is an international price control, but with the increase of Brazilian taxes, medicines sold in the country are among the most expensive ones worldwide.

— The industry buys medicines from abroad, brings them and has to sell them at the lowest price in Brazil. Then, the Brazilian government includes the taxes and the prices go up. It's a schizophrenic thing. And when a drug is taxed and sold to the government, the government itself pays the taxes — he criticizes.

The budget of the Ministry of Health, according to the executive, is R$ 25 billion, and about R$ 16 billion are spent only for purchasing medicines. 

—Healthcare is not a government policy, but a State one. No matter what the government is it has to follow a line that will be maintained. It cannot be changed for each president. Healthcare cannot depend on a game of political indications. Those who hold executive positions need to understand the issue and be committed to long-term healthcare — he defends.

Applying energy and resources to innovation and research, in order to make Brazil a competitive country with the rest of the world, is another point worth mentioning, according to the association. According to Pedro, Brazil needs to encourage, above all, the area of clinical trials, which brings resources and gives a direct feedback to the treatment of diseases amongst the population. And he adds that the pharmaceutical sector in Brazil imports 80% of raw material and finished medicine, which costs, on average, US$ 8 billion.

— We import because they research and do things abroad that we are not doing here. It is not fair that Brazilians have the same diseases and much less chances for having them healed - he says, adding that it is essential that there is commitment by the State in breaking the bureaucracies that hinder research in Brazil.

With that in mind, INTERFARMA has entered into a partnership with the newspapers O Globo and Valor Econômico, and Época magazine, to hold a series of scrutiny sessions with the five presidential candidates best placed in the polls. It was an opportunity for them, in two hours of interviews, to present their proposals for the healthcare sector and other areas of competence. Three of the five guests accepted the invitation, as follows:

Ciro Gomes
INVESTMENT IN RESEARCH

Ciro Gomes photograph by: Márcia Foletto/O Globo Agency

Investing in research is one of Ciro Gomes's flagships for health management. "We import US$ 17 billion in medical products a year, while we can produce drugs, prostheses, and other supplies internally, as we are empowered with the most sophisticated technologies. We are generating jobs in the United States, China and Europe with Brazilian money."

He highlighted the work of Fiouruz, which has created a unit for generating biological medicines - state-of-the-art products for the treatment of serious diseases, such as cancer. "Brazil can be the great global protagonist of this type of medicine, saving money, generating jobs here and exporting to the world," he said.

The SUS, for Ciro, is a generous program and must be preserved. "Nevertheless, we have to carry out the supervision and control of the emergency service units. We will set goals for health stations, such as reducing child mortality, maternal mortality, preventing diabetes and hypertension, and also checking the users' satisfaction ratio. The stations that attain the goals will receive R$ 100,000 per year."

On regulatory bodies, he does not agree that the directions for their commands are political and said that all agencies will be reviewed. "We will carefully check these agencies.”

Geraldo Alckmin
SUS FINANCING

Geraldo Alckmin photograph by: Márcia Foletto/O Globo Agency

Geraldo Alckmin defended that the SUS law is extremely correct, however, it needs better management and also a solution to its financing. He said that there are 34,000 beds unavailable for lack of resources in the country, while 32,000 works are being financed by the Ministry of Health. "We have to invest more in sanitation, vaccines and more sophisticated medicine for the elderly population."

A major problem for the industry, according to the candidate, is the judicialization. In São Paulo alone, R$ 1.6 billion was spent on health care in 2017. For Alckmin, the problem should be solved in technical chambers. "Judges cannot decide whether a certain procedure might be approved or not. And with technical chambers, these cases would not even have to go to courts."

On the population's access to sophisticated medicines, Alckmin highlighted the need to speed up clinical trial and approvals of the new molecules by regulatory agencies. "The main enemy of cancer in Brazil is bureaucracy. All over the world, one will not wait for so long to get the approvals. We must have a scientific rigor, but we cannot be slow, otherwise we will end up falling behind. We need to guarantee the distribution of medicines through a high healing power through SUS.”

Marina Silva
NATIONAL SANITARY AUTHORITY
Marina Silva photograph by: Márcia Foletto/O Globo Agency

Candidate Marina Silva's plan for the Healthcare segment is to promote a restructuring of SUS, dividing the service into 400 regional ones. These regional offices will have the role of optimizing resources and integrating public, private and philanthropic units. "In some regions, we have 50% of idle beds; in others, vacancies are lacking. "The regional offices will be coordinated by a national health authority, with the participation of states and municipalities.

The idea is to expand health coverage with a focus on Family's doctors, stimulating the training of general practitioners and, thus, investing more in prevention. "We need to offer highly complex diagnoses and make SUS a great service. The state must supply the country with good hospitals, which also serve as a standard for the rest of the network. The SUS will become a healthcare agreement for Brazilians. Complementary health should be only an option," said Marina.

Brazil should analyze good examples abroad
Looking abroad and identifying good examples of health management is one of the ways to leverage changes in Brazil. Europe, for example, supports a copayment model, where citizens are responsible for a small portion of the product consumed. The amounts are defined based on situations such as disease severity and integration of the elderly population in the country. The system dispenses biddings and the stock of products remains in warehouses, which also ends up reducing expenditure.

— One does not need to hire public servants to control that. Thereby, a mayor cannot distribute positions to friends either. The government only pays for what has been made available at pharmacies, namely which has been consumed. If boxes have been stolen or lost, it is the private sector's responsibility. It will run the whole risk by being accountable for logistics, inventory and so on — as pointed out by Pedro Bernardo, interim executive director of INTERFARMA.

The association believes that Brazil has the potential to improve the public health system, also betting on citizen awareness.

— Copayment creates a responsibility in the population, which will avoid waste. If we can improve the management, we will be able to do many other things and work in several aspects — Pedro emphasizes.

INTERFARMA believes that the solution for Healthcare in Brazil needs to be joint. The association raise the banner of debate as a way of contributing to the system as a whole, prioritizing the expansion of access to services and stepping up the management of resources.

— There are no solutions for a specific healthcare segment if it does not improve as a whole — explains Pedro Bernardo.

INTERFARMA intends to be a partner of the future government in the pursuit of quality public health, by dialoguing and making no pre-judgments about the service.

— This is an area that needs a humanitarian look. We have to think about people and look after the population — says Pedro.

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Bago
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