Reforming the Health Business

By Sarah O’Sullivan, Contributing Reporter

RIO DE JANEIRO – Jose Gomes Temporao, the national health minister, plans to “radically reform” Brazil’s public health care system. He openly acknowledges the anomaly that is public health, and blames antiquated administrative processes, some that are more than 50 years old.

Chantal James, a Canadian national living in Rio, had no private health plan when she became pregnant in 2007. Not overly concerned, she sought out the ‘best’ maternity hospital the public system had to offer. She remembers when her child was born. “It was horrific. Not so much the fact that the hospital didn’t have the latest in high-tech equipment, I could get over that,” she said. “I was treated like a second-class citizen, like I was a no-one. I had no say.”

Health care is a constitutional right for Brazil’s 190 million citizens. Public health care does exist, on paper at least, but the standard varies considerably. Optimum health care comes at a price, with dozens of private hospitals around the city offering a range of plans, with varying layers of cover.

Chantal’s experience is echoed in public hospitals across the city and country. Public hospitals are for the poor, and the poor have no apparent rights. Medical staff work in institutes that lack basic materials, such as medication at times.  Many complain that they do not get paid properly, if at all. In-patients regularly rely on family and friends for their basic care, and food.

In contrast, patients at the many private hospitals that dot the city are treated to the best of the best.  Those on a health plan enjoy private rooms, cable television, personalized diets catered for by nutritionists, and room service for visitors.

Temporao wants to keep the public system within the state portfolio, rather than privatizing it completely, or entering into public-private partnerships like many European countries. He proposes a new system of administration, one that “professionalizes management”, whereby the funding stream of public hospitals is directly related to performance, and meeting agreed targets.

Temporao told Jornal do Brasil newspaper last week that public hospitals currently receive the same funding package regardless of their performance. He’s pushing what he calls a radical reform of the health system through Congress at the moment; the implementation of state foundations as hospital governing bodies.

But, some health employees are not impressed with the new plans.  They don’t want to stray from the rest of the public service, and feel that their wages will dip. Temparao believes the opposite is true. Many philanthropic hospitals in the public sphere are functioning to the highest standards already, so why shouldn’t all, he asks. Wages would rise as employees fulfilled their roles more efficiently, he maintains.

But, whether Temporao’s so-called radical reform is will heal all, he believes remains to be seen. Many countries, like Ireland, regret the introduction of performance-based payments as a means of improving public services. There, bonuses are awarded to all, more or less, and systems remain as poor as before. The only difference now, is that organizations have become unbearably top-heavy with management.