With more money, you should ask for more results – Sustainable Health

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“Let’s stop this dangerous idea that the problem with the SNS is the lack of resources, which meant that, between 2015 and 2022, we had gone from a budget of 9 billion to 15 billion euros, with less activity and with less results”, said Adalberto Campos Fernandes, professor at ENSP NOVA, president of the administration of the Hospital da Cruz Vermelha and member of the Jury for the Sustainable Health Award, during the debate “Value-Based Health”, at the 11th conference of the Sustainable Health Award , an initiative by Sanofi and Jornal de Negócios, with NTT DATA as a knowledge partner.

In his opinion, whoever asks for more resources must be more efficient, because the money that was spent in excess in a certain area is money that is needed in other sectors. And he quoted Professor João Lobo Antunes, who said: “What worries me are not the resources I spend on my patients, it’s the resources I spend more on my colleagues’ patients.” But later Adalberto Campos Fernandes conceded that in this spiral of expenditure growth, which has no direct connection with care results and with the response, there is a part “that clearly goes to innovation, which is expensive and that every year adds value to the health care”. And he added that “the experience of the patient, who needs and has no wedges, we are not solving”.

No money or wedges

Rui Guimarães, Chairman of the Board of Directors, Centro Hospitalar Vila Nova de Gaia/Espinho, spoke about this experience of the patient who often does not have the answers that the system should give at the right time. He stressed that “it is possible in the area of ​​integration of primary health care and hospitals to put the system at the service of the person and not the other way around”. But so far, “people who went to the hospital emergency ten times went to primary health care ten times, and these are the fats that can be eliminated, giving meaning to the patients’ journey.”

It is possible in the area of ​​integration of primary health care and hospitals to put the system at the service of the person and not the other way around. Rui Guimarães
Chairman of the Board of Directors, Centro Hospitalar Vila Nova de Gaia/Espinho

Rui Guimarães added that “it is not a purely economic issue, I often feel that the money is already in the system. consumption of hospital emergencies in our system and that spends a lot of money on our taxpayers.”

We have to focus on the right of access, which are constitutional rights, important and relevant social rights. Either we manage to ensure all the answers to those who need it through public means or we have to ask the social and private sector for help without any kind of embarrassment. Adalberto Campos Fernandes
professor at ENSP NOVA, president of the administration of the Red Cross Hospital

According to Adalberto Campos Fernandes, these inefficiencies generate a country at two speeds. One with 5 million Portuguese people who have second and third coverage because they have health insurance or ADSE, and another in which “we have five million people who don’t have money or coins”. In his opinion, “we have to focus on the right of access, which are constitutional rights, important and relevant social rights. Either we can ensure through public means all the answers to those who need it or we have to ask the social and private sector for help without any kind of of constraints”.

The SNS has trust capital with people

Adalberto Campos Fernandes said that “we have one of the best health systems in Europe and one of the best in the world, we have excellent medical training, which places us in the top 10 in Europe in terms of medical quality. We have everything to do well, with the limitations economics and resources we have”.

“Policy discontinuity is a very serious matter that cannot happen, there must be a minimum strategic consensus on health for the country as there is for national defense, education. Then there are conjuncture policies that are of the majority that are on duty” , underlined Adalberto Campos Fernandes.

He confessed that he has great expectations in the work of Fernando Araújo, the new executive director of the SNS, who was his secretary of state when he led the Ministry of Health between 2015 and 2018, and the new minister of Health, Manuel Pizarro. “With 15 billion euros, with political stability, with a minister who is politically experienced, who knows how to negotiate and speak with stakeholders, who knows the life of hospitals, in dialogue it is possible to give hospitals the autonomy they need. No matter the color of the counter, managers have to deliver the results they contract and customer satisfaction if the person left cured or improved and was treated as a person, because they want to be treated with dignity at the right time, by the appropriate professionals”.

Do not mistreat the SNS

In turn, Rui Guimarães recalled that the SNS had a great performance during the pandemic, in difficult times in which “many people privileged their public service, their mission, as an alternative to being at home with their own families, and that did not is duly recognized”. He pointed out that, despite the operational difficulties that exist on the ground, it is also necessary to reinforce that, despite everything, the SNS continues to be the main health service provider and that, often, it solves what has reached the limit of other partners.

“The SNS has enormous recognition from the population. It was important that we, who have an important role in organizations, do not feed too much into the way of mistreating the SNS, because we are mistreating patients who need it, we are creating a climate of mistrust in regarding care, and we are also discrediting the system itself. We must not contribute to taking away the trust capital that people have in the SNS”, stated Rui Guimarães.

The National Health System has the electronic prescription because it was the Faculty of Medicine of Porto that computerized the Infarmed drug databases. Altamiro Costa-Pereira
director of the Faculty of Medicine of the University of Porto

Adalberto Campos Fernandes said that “we have one of the best health systems in Europe and one of the best in the world, we have excellent medical training, which places us in the top 10 in Europe in terms of medical quality. We have everything to do well, with the limitations economics and resources we have.”

The complaints of the Faculty of Medicine of Porto

“The National Health System has the electronic prescription because the Faculty of Medicine of Porto computerized the Infarmed drug databases”, said Altamiro Costa-Pereira, director of the Faculty of Medicine of the University of Porto. “It was a very well done job that still works today, but it was poorly paid. The real price we had to pay, for having done a good job, was that we never set foot in Infarmed or Lisbon again.”

The Faculty of Medicine of Porto has had a drug-surveillance unit for many years, “it is certainly the best, and they gave us an award that was to stop doing the North and just stay with Porto”. But Altamiro Costa-Pereira’s complaints do not stop there. Recently, the consortium formed by ESEP – Escola de Enfermagem do Porto, Faculdade de Medicina do Porto (University of Porto) and Escola Superior de Saúde do Porto (Polytechnic Institute of Porto) presented, within the scope of the PRR, a program called IP Alliance, to train joint teams of doctors, nurses and other health professionals in simulation systems, as is done in aviation. “We asked at the time about 15 million, we received 200 thousand euros”.

How to finance efficiency “It is not taboo that the cost of a patient treated in the Lisbon region or in the North region is substantially different, with less costs in this one, there is a very large margin”, said Rui Guimarães, Chairman of the Board of Directors, Centro Hospitalar Vila Nova of Gaia/Espinho. He pointed out that many inefficient managements continue for years and that has a price to pay both financially and morally. In financial terms, it is a cost of efficiency and costs everyone money, on the other hand, “the troops completely lose the will to do more and better when you don’t have a good example”.

If a hospital cannot fail to receive funding, because, as Adalberto Campos Fernandes says, “it doesn’t cross anyone’s mind to close a hospital because the State has to look at all Portuguese people and the territory as a whole”, there could be forms of positive discrimination for the most efficient, with more results and with more value in the care provided.

As Rui Guimarães underlines, “the hospital pays for each customer that it sees in the emergency room and has the same value, whether for a toothache or for a polytrauma accident that requires months of care”. He says that even if quality criteria are later included and there are barriers and limits, “the way we contract health with providers is deficient”.

He uses the example of his hospital, which has a 24-hour team performing interventional neuroradiology. “If this rehabilitates the person, who returns to society doing exactly what he used to do and in another hospital a person stays in a bed under the care of others, the hospital should not receive the same amount of funding, it should even be, in some cases, prevented. to treat some pathologies for the results they don’t have. And this information has to be public”, considers Rui Guimarães.

For Altamiro Costa-Pereira, director of the Faculty of Medicine of the University of Porto, there is a lack of recognition from hospital managers and health professionals and “typically it is better to be inefficient than to be efficient, because if you are inefficient you are always guaranteed that someone will pay the invoices, if it is efficient it costs you more to do so and then you have absolutely no advantage”.

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