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EF: Could you elaborate on the role of ANAHP and what is on the top of your agenda?
AB: We work on behalf of private hospitals and through the pandemic that was just one priority; how to help the people of Brazil and the public health system in fighting against COVID-19. That was our first, second and third priority. Despite all the problems Brazil faced, we ensured that the plans worked on a local and regional level. We are proud because, with telemedicine, virtual meetings and a strong job, private hospitals could help the public sector. But we need to go ahead, and the priority after the pandemic will be to focus on the thousands of delayed surgeries and treatments because of the pandemic. These are the pandemic consequences, and we will have to face them. It will be a tough challenge for us.
A third priority is related to the Brazilian structure for healthcare. We have many problems in financing the public health system, SUS. One responsibility of the system is to pay for treatments and surgeries, but it does not have the money for that. This is a daily problem as the constitution states that we must care for the whole population, but the federal government cannot fund this. As a result, all private hospitals have a huge task. There are around 48 million Brazilians that have private health insurance, and the economic challenge for the hospitals is how to receive money from the private sector based on private insurance, and with this money to first pay the debt of SUS and secondly invest and modernize. In one words, the private sector is facing structural problems which can create more problems. Brazil needs to urgently rethink and reform the healthcare system. We need to improve primary attention and the level of integration between the private and public sectors.
EF: Could you elaborate on the lessons learnt through the pandemic for the private sector?
AB: One of the most important lessons for the private sector was everyday reinvention. Today, hospital management teams are more flexible, more creative, and more organized. There are so many extraordinary examples of small hospitals drastically increasing their treatment capacity. The human capital was a group of heroes.
EF: What changes would you make to the Brazilian healthcare system?
AB: The increase of telemedicine. It is the way to cover the gap between the capacity and the necessity shown by the people. Without it, we will collapse.
We do not have communication structures for telemedicine, and we do not have medical colleges, but despite a long list of lacks, telemedicine was imposed by reality and necessity. We have incredible figures in the private sector, 6.5 million use telemedicine. I hope after the pandemic we can organize a telemedicine system. To do that, we need to prepare people to work in telemedicine, we need to define what we want with telemedicine, it must be a way to improve access and not only a way to reduce costs. Telemedicine is probably the biggest opportunity to make Brazil more equal, particularly through transforming access for poor people and those living in rural areas.
EF: What is your definition of access?
AB: There is no country in the world that can offer everything for everyone, but countries like Brazil must-have conditions to offer basic access with dignity. Brazil is a phenomenon for healthcare because we have communicable diseases from three different centuries, the 19th, 20th and 21st, and combatting those is access for me.
EF: What do you think the future of health looks like?
AB: Hospitals must be hubs taking advantage of telemedicine, what we are seeing in Brazil in the best hospitals is that they are becoming centres of research, development, and treatment from the beginning of life through to the end. This means a generational difference, from thinking of hospitals as places that fight against diseases to places that take care of promoting health.
We are also seeing the development of Homecare in Brazil. The process of ageing is very fast in Brazil and so homecare is increasing, but the challenge is promoting it as access questions are also present in the homecare issue.
EF: What do you think the world can learn from the way private hospitals are run in Brazil?
AB: Our hospitals learned a lot and are very well run with highly skilled management; they offer medicine updated with the best practices in the world. Brazilian physicians and researchers have a beautiful skill in medicine compared with a lot of researchers, and we are proud of that. But the facilities in Brazil are highly concentrated in the south and the centre, many areas do not have physicians.
