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EF: How has the supplementary health sector evolved in the last two decades, and what are ANAHP’s priorities for 2024?
ET: In the past four years, our healthcare sector in Brazil, like the rest of the world, has faced significant financial barriers. Since the COVID-19 pandemic, the private hospital sector has been under intense pressure from health insurance companies in Brazil, which have been implementing aggressive policies of denial and delayed payments for hospital services. To address this complex scenario, we have adopted a dual approach. Firstly, we engage in ongoing dialogue with insurance companies to enhance the relationship between insurers and hospitals. We also collaborate with Brazil's supplementary health system regulatory agency (ANS) and other stakeholders in the healthcare industry.
Secondly, we actively promote discussions and solutions through debates, workshops, events, and knowledge sharing on best practices and operational efficiency in the hospital sector. These two strategies represent our primary efforts in response to the challenges we have encountered in the healthcare system.
EF: What initiatives are ANAHP and its partners working on to reform the system?
ET: We have been actively engaging with all stakeholders to address challenges and advocate for important healthcare initiatives. Currently, several significant projects are being discussed in the National Congress of Brazil, including regulations for clinical research, the implementation of a national electronic health record, and the establishment of a national health data network that integrates artificial intelligence into healthcare. We are collaborating with all parties involved in these discussions to advance these crucial topics.
Investment is another critical aspect that requires a collective effort to improve the regulatory and bureaucratic landscape in Brazil. We are committed to working together with stakeholders to overcome these challenges this year. Our collaborative efforts involve initiatives to reduce insurance denials, facilitate hospital partnering to develop primary care solutions and aid the healthcare industry and insurers in exploring more efficient payment models focused on value-based care.
Fee-for-service remains the predominant payment model in Brazil, but we are working towards risk-sharing strategies, particularly with the incorporation of high-cost drugs into healthcare systems. These discussions highlight the potential for concrete actions moving forward.
Engaging with the private sector can help improve the healthcare system and overcome these payment challenges. I believe that it will take a couple of years to see significant improvements as we continue these dialogues and collaborations with other stakeholders. This ongoing engagement with the sector remains our top priority and is essential for implementing effective actions and initiatives to address the challenges faced by the healthcare system in Brazil.
EF: Is there a way to optimize this process so that it can be completed on a shorter timescale?
ET: We are working with insurance companies to address the financial challenges within the system. These discussions are focused on developing sustainable solutions to the current financial issues. The insurance sector anticipates spending one to two years recovering from these challenges. Implementing change within the industry can be a time-consuming process, especially when it comes to transitioning to value-based healthcare. While this approach is gaining traction globally, implementing it in Brazil is particularly challenging due to the country's size and socio-economic disparities. We must address fundamental issues first to make meaningful improvements.
EF: Can you share any notable success stories from either large or small hospitals where they have maximized their limited resources effectively?
ET: We have noted some actions in hospitals that showcase effective resource management. For example, the A.C. Camargo Cancer Center works closely with the pharmaceutical industry on specific protocols and healthcare programs. On the other hand, hospitals like Hospital Israelita Albert Einstein have established innovation centers that foster the development of healthcare startups.
EF: How do you see telemedicine evolving in the future, and how long do you think it will take to improve access in remote regions?
ET: During the pandemic, there was significant progress in telemedicine in Brazil, facilitated by collaborations between private hospitals and the public sector. This collaboration helped extend healthcare services to challenging locations, ensuring access to care for those in need. We still have a long way to go to get increased access and maintain the same rate of growth we saw during the pandemic.
EF: What initiatives are you pursuing with your partners in terms of digitalization or technological advancement?
ET: Our approach involves integrating them into our hospital environment by inviting them to participate in our congresses, events, and discussions focused on innovation and the challenges we face. Their involvement contributes significantly through knowledge sharing, networking, and participation in our CONAHP congress, our largest event that last year brought together more than 5,300 healthcare executives. This congress serves as an opportunity to collectively address sector challenges and explore collaborative solutions.
EF: How can advancements in the private sector have an economic spillover to the rest of the country, and vice versa? How can improving the public system (SUS) positively affect the private sector?
ET: Our mission as a representative organization is to promote the quality of medical and hospital care in Brazil, both private and public. We understand that we have a responsibility to the healthcare system, and many initiatives have led us to this objective.
ANAHP believes that data measurement is an essential part of the evolution of healthcare. That is why the ANAHP system of hospital indicators has been made available for free use by public hospitals. Our purpose is to promote qualified benchmarking for these organizations and provide tools that help drive quality improvement. We also provide free participation for managers of public institutions in our events, such as CONAHP; we believe in sharing qualified knowledge.
We engage extensively with the Ministry of Health to enhance the integration of private and public healthcare in Brazil, recognizing the complexities involved. 75% of the population in Brazil is served solely and exclusively by public health and heavily relies on support from the private sector. For example, about 70% of complex surgeries within the public system are conducted in private hospitals, highlighting a significant level of integration. The health minister is increasingly recognizing the benefits of this partnership with the private sector, and we are encouraged by the progress in this area. We are going to start a partnership with the health minister to bring more hospitals to our system of hospital indicators.
EF: What is the system of hospital indicators and what does it provide?
ET: We operate a platform that aggregates numerous indicators related to our hospital systems, encompassing quality and financial metrics. This platform incorporates over 250 indicators specifically tailored for the hospital sector. Annually, we release our "Observatório," which uses data from the system as a source, gathering the main information in this material, which is available to everyone. This publication details the technical specifications of all collected indicators and provides insights for participating hospitals. It functions as a benchmarking initiative aimed at enhancing performance across the healthcare sector. You can use this platform to compare your institution to others which have also provided us with their data.
This platform had existed for almost 20 years before we started to collect data. Over the years, we worked on improving this platform until it became the product that we have today. I think it is the most important system of information about hospitals in Brazil. Almost 200 hospitals participate in this initiative, and we hope to grow that number through collaboration with the Ministry of Health.
