Closure of dialysis clinics affects SUS patients – 07/12/2023 – Health

Dialysis clinics are closing their doors or ceasing to serve SUS (Unified Health System) patients, claiming economic unfeasibility. As a result, patients have to travel even greater distances for their weekly sessions.

The president of ABCDT (Brazilian Association of Dialysis and Transplant Centers), Yussif Ali Mere Junior, says that there is a serious crisis faced by private clinics, which serve about 87% of SUS patients, about 130 thousand, submitted to this type of treatment. In hemodialysis, a machine filters and cleans the patient’s blood, doing part of the work that the diseased kidney cannot do.

The Ministry of Health tells the Sheet having readjusted the value of conventional hemodialysis in the SUS table and which will give an extra incentive to smaller clinics.

Representing 840 private clinics, Mere Junior says that the situation has worsened during the Covid-19 pandemic due to the lag in the SUS table and the increase in the prices of inputs. The combination of these factors, he adds, negatively impacted the economic viability of the establishments.

A survey carried out by ABCDT indicated that, since 2017, 42 outpatient clinics have closed their activities across the country due to financial insolvency. Only this year there were six clinics.

Other units stopped serving SUS patients or reduced the number of vacancies for this public. In Rio de Janeiro, for example, the association identified three clinics that stopped serving SUS in the last two years.

“Many clinics are indebted, many others have already closed and there is a risk of patients being left unattended. It has been common for clinics not to accept more new SUS patients. There is an increase in vacancies for health plans, but they cut SUS patients”, he says.

Verônica da Silva, a nephrologist nurse and owner of the NefroCastro clinic, ended its activities on June 30 of this year. The unit assisted 73 SUS patients in the city of Castro, Paraná, and region.

According to her, the amount received by the clinic per session was insufficient to cover the costs of hemodialysis, including the structure of the clinic and the salaries of employees.

She says that she even increased the number of patients seen per technician from 4 to 6 to try to get around the situation. But without success.

“The delay in transferring payments was a decisive factor for the closure of the clinic. We served exclusively SUS patients, which made it unfeasible to continue receiving payments after a delay of two months, for example.”

Retired Lelia Oliveira Almeida, 40, had been undergoing hemodialysis at NefroCastro for 12 years and, with the closure of the site, had to seek care in the city of Telêmaco Borba (PR).

Now, she leaves home at 6 am in the car provided by the city hall to transport patients and returns around 7:30 pm. This script is repeated three times a week.

A resident of Jaguariaíva (PR), she would travel 80 kilometers to Castro in about an hour. Now, it’s three hours to tackle the 155 kilometers to Telêmaco Borba.

“The fact of having to leave the house in the morning and return only at night negatively affected my quality of life. I get more tired and I don’t have the same people to take care of me, they were like part of the family, a strong bond of friendship was created It is important that it helps in the treatment”, he laments.

Maria de Lourdes da Silva Alves, president of the National Federation of Associations of Renal and Transplant Patients in Brazil, says that Lelia’s case is not an isolated incident, but a reality that has been observed throughout the country.

According to Alves, the sector lacks interest in opening clinics aimed at caring for SUS patients.

In some states, measures are being taken to alleviate this situation, as is the case of Santa Catarina, where the state government adopted the co-participation model to face the problem.

Alves highlighted that in Rondônia, for example, patients need to travel three hours to get to the clinic, another three hours to return home and, even so, they spend four hours undergoing the hemodialysis procedure.

“If there are no policies aimed at primary care, the problem will worsen even more”, she says.

Nor did the clinics managed by Jaberson Severo in the Rio Grande do Sul cities of Alegrete and Rosário do Sul survive financially. Debts piled up, and services ended up being handed over to hospitals.

“In a period of ten years, the price of the procedure was readjusted by 22%, which did not even keep up with inflation (IPCA varied by more than 79% in the same period). Most inputs and machines are imported and in the pandemic the problem got worse”, he says.

According to Rodrigo Cariri, general coordinator of specialized care at the Ministry of Health, the portfolio made a 10.3% increase in the value of conventional hemodialysis in the SUS table in June. R$ 400 million will be allocated to fund the readjustment, which was calculated taking into account items related to the procedure, as well as personnel costs.

The ministry will also allocate R$ 200 million as an additional incentive for smaller dialysis clinics. These funds will be used to maintain the services’ equipment.

A specific amount per machine will be set aside annually for clinics with up to 29 machines. For those with 1 to 19 machines, the amount will be R$ 53,000 per machine per year. For clinics with 20 to 29 machines, the cost will be BRL 9,000 per machine.

“On the part of the Ministry of Health, we recognize that there is a historical gap in relation to the spending ceiling, constitutional amendments and previous fiscal austerity measures that we are trying to mitigate with the efforts that fall to this management, but we have no news of a crisis installed in no state. It would be of interest even for the purposes of transparency if we could know the clinics that closed and have that on the radar”, he says.

He points out that the last readjustment had been 12.5% ​​in 2021 after an interval of four without readjustment and high inflation.

Cariri added that the department has been working on care for chronic kidney patients, and hemodialysis is part of the treatment. Among the measures is the expansion of care for people who are not yet at the stage of undergoing the procedure, the pre-dialysis.

“We are also facing the legacy of denialism, we spent four years with absolutely no care measures that lead the patient to dialysis, such as hypertension, diabetes”, says the general coordinator.

Mere Junior, president of ABCDT, says that the readjustment proposed by the Ministry of Health is a response to the sector’s request for an update of the SUS table and will not be enough. The value transferred by the SUS for each hemodialysis session is 39% lower than the actual cost of the service, according to him.