In the week marking World Health Day and World Cancer Day, the Director-President of the National Supplementary Health Agency (ANS), Wadih Damous, argues that the health care model focused on reacting to problems and treating diseases needs to be overcome. “It is a reactive model.”
In an interview with Agência Brasil, Damous considers prevention and health promotion as essential parameters and proposes a broader dialogue with the sector to build a new health care model. “Even from the perspective of those in the sector who want to ensure profitability, it reduces costs.”
The ANS is a regulatory agency linked to the Ministry of Health responsible for the health insurance sector in Brazil. In simple terms, regulation can be understood as a set of government measures and actions involving the creation of norms, control, and oversight of the segment.
The Director-President of ANS advocates for health literacy as a tool for health plan beneficiaries to make more informed decisions and for the operators themselves to participate in this process. “I cannot conceive of supplementary health as a mere conglomerate of companies.”
“In more than 700 Brazilian cities, various types of cancer have already surpassed, in a grim ranking, the traditional first place held by cardiovascular diseases. And the grim forecast is that by 2029, cancer will top this ranking of the highest incidence of diseases in the country,” he said. “We have to prepare for this,” he added.
Below are the main excerpts from the interview:
Agência Brasil: This week we remember World Health Day. How do you evaluate the health care model that focuses on reacting to problems and treating diseases?
Wadih Damous: This model needs to be overcome. It is a reactive model. And this is not only my point of view, but it is also the view of various specialists in the medical field, in public health here in Brazil. It has been concluded that this paradigm is costly and inefficient. A large part of the operators’ healthcare expenses is concentrated on managing complications that are preventable or treatable if correctly diagnosed and with the necessary advance, such as diabetes, hypertension, obesity. And that is not how it happens.
Our understanding is that health should be managed intelligently, and this will indeed require a change in this institutional culture. I also understand that we should transition from this volume-based payment model, which operators complain about so much and which ends up encouraging unnecessary tests, to the logic of generating value in health through planned care lines, prevention. This reduces costs, preserves life, and ensures a better quality of life.
Agência Brasil: Are prevention and health promotion today non-negotiable factors for the sustainability of supplementary health?
Damous: As I am the head of a regulatory agency and my scope is supplementary health, I cannot say they are non-negotiable. Everything here, in our scope, is built from negotiations and dialogue. But I would say they are essential parameters. What I want is to promote a broad dialogue with the sector, with operators, with providers, including hospitals, clinics, and the like, to build this new model. I am optimistic and believe that a dialogue based on evidence and showing that this, even from the perspective of those in the sector who want to ensure profitability, reduces costs. I hope this new vision will sensitize these sectors.
Agência Brasil: What is the importance of health literacy as a tool for health plan beneficiaries to make more conscious decisions?
Damous: This is not a matter restricted to supplementary health. It is a public health policy that should be led by the Ministry of Health, and ANS should echo it. In what sense? It is a process of convincing the private health sector here in Brazil, which involves more than 53 million users. It is an imposing sector that reaches a substantial portion of the Brazilian population. We need to integrate this literacy campaign and clarify the need for prevention. How many diseases that become lethal could be avoided if there was prevention?
Convincing people to have regular check-ups, to see a doctor periodically, to exercise, and to adhere to a healthier diet. All this is health literacy. Now, this requires a well-organized campaign that indeed translates, in simple language, this need. And convince people that it is not just about taking medications and measures when the disease has already settled in the body. So that people can understand that prevention can be the key to a long, healthy life with good quality.
Agência Brasil: What is the role of operators in this health literacy strategy?
Damous: Use their communication channels, guide their accredited professionals, doctors, offices, hospitals, clinics to integrate this campaign and clarify their patients. And that this is expressed in the products offered through health plans. This is something that, within supplementary health, I want to organize a project and submit it to operators for adherence. So that it is also attractive to them. Then we can act as a system. Because I understand that supplementary health is a system, just as there is the public system, there is the private system. I cannot conceive of supplementary health as a mere conglomerate of companies.
Agência Brasil: At the beginning of this week, a law was published requiring companies to provide information about vaccination campaigns against HPV and about breast, cervical, and prostate cancers. What are the impacts of this new legislation on supplementary health?
Damous: We will see this over time. President Lula sanctioned this law, including providing for the incorporation of immunotherapy treatments in the SUS [Unified Health System]. We have a normative resolution that establishes and authorizes immunotherapy treatment in some cancer modalities. The law covers 40 types of cancer – much broader than what is provided for in the ANS list. This will likely be incorporated into our list of procedures. From there, we will have a notion of the regulatory impact, the impact on the sustainability of the system. But it was an advance in the SUS, and I hope it will also be an advance in supplementary health. We are dealing with lives and health.
Cancer, today, in Brazil, is growing in epidemic proportions. In more than 700 Brazilian cities, various types of cancer have already surpassed, in a grim ranking, unfortunately, that traditional first place held by cardiovascular diseases. And the grim forecast is that by 2029, cancer will top this ranking of the highest incidence of diseases in the country, which is already happening in some parts of the world, such as industrialized countries, countries with greater aging. We have to prepare for this.
The joint action between supplementary health and public health must have, as one of its pillars, the fight against the advance of various types of cancer.
Agência Brasil: Does the employee’s right to leave for preventive exams contribute to early detection and adherence to cancer treatment?
Damous: Without a doubt. One of the issues that have produced this epidemic advance of cancer is the lack of early diagnosis, the late care in the SUS and sometimes even in supplementary health. Often, when the tumor is detected, it may already be too late, it is already in a phase of lethality or irreversible sequelae. I repeat: we have to treat it as a public health policy, in the line of care and prevention. Many of these tumors could be avoided, mitigating their lethality, if treated in time, with periodic exams that detect the disease at its onset. Many of these cancers are almost 100% curable if detected in time.
Agência Brasil: How do you see the debates on mental health and work schedules within the scope of supplementary health?
Damous: The World Health Organization [WHO] has reports, involving the whole world, indicating an increase in cases – and an increase in epidemiological degree – of mental health, of Burnout in many countries, generating episodes of suicide, deep depression. And this has already become a public health issue. The supplementary health sector cannot be oblivious to this issue. In this sense, we fully support the government’s proposal to end the 6×1 scale, which refers to aspects of slavery, because it does not allow people to have more leisure time, to spend with family and friends, to educate themselves culturally and educationally. All this relates to mental health.
And physical health accompanies mental health. If mental health deteriorates, consequently, the various chronic diseases that people have end up consolidating – hypertension, diabetes, obesity. This is a fundamental debate, very current, and it should be addressed with all attention, based on technical-scientific evidence. But we must be clear that it is a public health issue. And supplementary health cannot be oblivious to this scenario.
Source: Agência Brasil.
Original published at O Cafezinho.