1/3 of people from São Paulo with plans seek the SUS for hospitalization – 05/17/2023 – Health

More than a third (34%) of residents in the state of São Paulo with health plans use public hospitals when they need hospitalization. Another 28% also resort to SUS for medical appointments and 27% for laboratory tests.

When it comes to vaccines, almost 9 out of 10 (87%) users of supplementary health seek immunization at UBSs (Basic Health Units).

The results are from an online survey by the Qualibest Institute, commissioned by Sindhosp (Union of Hospitals, Clinics, Laboratories and Health Establishments of the State of São Paulo), with 2,013 residents of the São Paulo capital, interior and coast. The margin of error is 2.23 percentage points for the total sample.

Most interviewees claim not to have health insurance (58%), against 48% of those who say they do. Of this total, 64% reported using public and private networks: 31% only public and 5% only private.

According to physician Francisco Balestrin, president of Sindhosp, it is possible that the high percentage of those who use both networks is due to the PNI (National Immunization Program), which covers the entire Brazilian population with vaccines for all age groups.

“It also has to do with the Covid-19 pandemic, since it was the public sector that provided the vaccines”, he says.

Among the interviewees, 96% of SUS users and 87% of those who have health plans claim to resort to UBSs for immunization. Private clinics and laboratories are an option for 21% of those covered by health plans.

For medical appointments, 90% of people without health insurance use the SUS. But 26% of them also look for popular clinics and 14% for private doctors. Among supplementary health users, 28% seek doctors from the public network; 89%, health plan professionals; 26% from popular clinics; and 25% private physicians.

When they need to perform tests, 86% of those with health insurance seek accredited laboratories, but almost 3 out of 10 (27%) also resort to public laboratories. Clinics with more affordable prices are an option for 28% of SUS users and for 23% of those with plans.

For hospital care, 97% of respondents without health plans resort to public hospitals, which have agreements with the SUS and the UPAs. This is also the option of 34% of users of health plans, although the vast majority use the accredited network of operators (85%). Private hospitals were cited by 16% of those with plans and by 7% of SUS users.

In Balestrin’s opinion, the data on the use of the SUS by people with health plans make it clear that the private health sector necessarily needs to feel part of the SUS. “It doesn’t have to have a public and private health system. It has public and private funding. But it’s a single health system.”

Mario Scheffer, professor at the department of preventive medicine at USP, says that the person with a plan goes to the SUS or pays out of pocket to have access to doctors, exams and hospitalizations due to denial of coverage by the operator or because the product, in general, a lower price plan, does not have what it needs in the partner network.

“This reality already appears in the population surveys of the IBGE [Instituto Brasileiro de Geografia e Estatística]. The fact is that most people who have plans in São Paulo, most linked to the collective plan of the company they work for, have contracts with coverage restrictions and an insufficient or poor quality provider network.”

Scheffer claims that, with the “prohibitive” readjustments of plans for individuals, families and employers, there is more and more replacement of a contract by another cheaper and worse coverage. “These are the people who appear in surveys reporting using the SUS more or paying privately, even though they have a plan.”

The issue of access (or lack of access) is so important that, for most respondents, it is confused with the very concept of health. For 66%, health is having access to a system for prevention, care and treatment. According to the WHO (World Health Organization) definition, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Another 44% mention that health is having a good diet. Regular physical activity and the absence of diseases appear tied for 37% of respondents. A third (33%) say that health is having frequent medical follow-up and, for 31%, up-to-date exams.

According to international data, 85% of health demands can be resolved in primary care. The UBSs and the ESF (Family Health Strategy) program should be the gateways, but the survey results show that most SUS users (67%) do not follow up with a general practitioner or family health team.

Among those who have a plan, this percentage drops to 40%, that is, most beneficiaries of supplementary health (60%) claim to do this type of follow-up. Those who do approve the service they receive. The “good” concept index is practically identical among SUS users (54%) and among supplementary health beneficiaries (53%).

For the state secretary of Health, Eleuses Paiva, another point that also draws attention in the survey is the fact that the majority of the population recognizes the UBS (94% know what it is) as the gateway to the health system, knows which it is the unit you should look for, but the assistance offered in primary care is inefficient.

“Teams need to be trained so that care becomes more resolute and there is no progression in the search for more complex services”, said Paiva to Sheetby text message.

Most people report looking for a UPA when they need a medical consultation. This occurs with 70% of people who have plans and with 57% of SUS users.

According to the secretary, another important issue raised by the survey is the low use of telemedicine in the SUS. Just over half (51%) of those who have health plans have already used this type of assistance, against just 13% of those who depend on the public system. “If expanded in a structured way and with quality, it represents an important tool for expanding access”, says Paiva.

For Balestrin, during the pandemic, the private sector was more efficient than the public in increasing access to telemedicine. The survey points to a similar approval rate for this type of assistance between the two audiences: 72% among those who have plans and 69% among those who do not.

The survey also exposes difficulties in accessing the SUS: 83% of respondents report obstacles. Waiting lines were the main obstacles for 54% of them, followed by referrals for tests (38%).

Among those who needed to be admitted to a public hospital, 56% said they had no difficulty. Of this total, 64% are SUS users and 37% are beneficiaries of the supplementary sector.