Health plans will be able to reduce debts when treating SUS patients

Health plans will be able to deduct reimbursement debts owed to the Unified Health System (SUS) when treating patients in the public health system. The ordinance formalizing the measure was presented this Monday, the 28th, by Health Minister Alexandre Padilha , Attorney General Jorge Messias, and the president of the National Supplementary Health Agency (ANS), Carla de Figueiredo Soares.

The expectation is that SUS patients will be treated in the private network starting in August. The measure is part of the Agora Tem Especialistas program and will prioritize six areas with the greatest need for specialized services: oncology, ophthalmology, orthopedics, otorhinolaryngology, cardiology and gynecology.

According to the Ministry of Health, the demand of states and municipalities will also be considered, as they will present their needs. It is estimated that, initially, R$750 million in debt owed by private health providers will be converted into consultations, exams, and surgeries.

Debts arise because health plans must reimburse the SUS when health plan beneficiaries use public services that are covered under the signed contract.

Operators wishing to participate in the program must adhere to the joint call for proposals from the Ministry of Health and the National Health Agency (ANS). They must demonstrate technical and operational capacity and provide a supply matrix that meets the needs of the SUS. According to the Ministry, the advantages of joining the call for proposals include fiscal regularity, the use of the full capacity of partner hospitals, and the reduction of administrative and judicial disputes.

The amounts to be converted into services will need to be negotiated with the ANS (National Health Service) or the Federal Attorney General's Office in the case of outstanding debts. Health plans must provide more than 100,000 services per month. Exceptionally, a minimum value of R$50,000 per month will be considered for smaller health plans.

"This is the first time in the history of the SUS that we've implemented a mechanism like this. Debts that previously went to the National Health Fund but weren't converted into care have now been turned into concrete actions to reduce waiting times and provide dignity to those most in need," said Minister Alexandre Padilha.

Integration platform

The Ministry of Health also announced that data on services provided by the public and supplementary health networks will be integrated into the National Health Data Network.

Starting in October, patients are expected to have greater autonomy and ease of access to their medical records. They will be able to view exams, prescriptions, diagnoses, and treatments performed by the SUS (Brazilian Unified Health System) and hospitals, clinics, and laboratories affiliated with health plans.

According to the ministry, information from the supplementary network will prevent repeat exams, reduce costs, and improve diagnoses and treatments.

Integration with the SUS platform will occur in stages. Between August 1st and September 30th, the National Health Data Network will receive population data from 2020 to 2025. Starting in October, the transfer will be automatic as services are provided.

Health plan data will be accessible to the public via the Meu SUS Digital app. SUS professionals and managers will be able to access it via the SUS Digital Profissional and SUS Digital Gestor platforms, respectively.

The Ministry of Health expects the volume of records in the National Health Data Network to increase from the current 2.8 billion to over 5.3 billion. The SUS platform already contains information related to public health services: more than 80% of Brazilian states and 68% of municipalities use the network to organize and plan initiatives.