The suffering of Brazilians with health plans

“A lot of poor health and salvation is a disease in Brazil.” One of the most famous phrases in Brazilian literature in Mário de Andrade’s book Macunaíma serves to reflect on one of the country’s most problematic issues, the health of its citizens. This time, it is the decision of the High Court of Justice (STJ) that calls for attention and is of concern to more than eight million people, changing the list of mandatory coverage for health care providers. The Court has ruled that from now on it is a complete list of surgeries, surgeries, therapies, medicines, etc., including economic activities for the insured patients. That is, health plans, which previously required the courts to pay the bill if consumers needed to perform new procedures, are supported by denying treatments and medications. According to the decision, companies no longer have to bear the costs of treatments outside the official role of the National Supplementary Agency for Health (ANS), even if there are penalties for doing so.

“The insurance company denied me medication, testing and immunotherapy. I’ve had to file a lawsuit against the plan several times. “ Ana Maria Teixeira Eland, 66, a patient receiving cancer treatment

In fact, what the STJ did was throw a cold shower on consumers, as the Judiciary itself accepted, through various decisions, that the list was an example, and that, depending on the situation, it would have to include other procedures. In short, the 3,300 procedures on the list as a must for health insurance are fast becoming available for anyone who needs a new therapy. People receiving treatment may be temporarily discontinued. As the field of medicine is dynamic, innovations are constantly emerging. “It’s a bad decision. Now, people will have to pay for innovative treatments, ”says Renata Abalém, a specialist in consumer law and a member of the OAB-SP Consumer Law Committee. He is right. “Today, there are adults who have been diagnosed with autism, and with it, different needs arise,” he says.

REACTION For Senator Mara Gabrilli, Many People Won’t Be There Now (Credit: Kleyton Amorim)

The recognition of innovations really happens. Innovations are included in the coverage list of healthcare providers. However, this update does not happen overnight. It takes a very long one hundred and eighty days, and only medicines, technologies or therapies are accepted after this period. “A new drug is the time it takes, for example, to study with the necessary scientific rigor,” said Vera Valent, executive director of the National Federation of Complementary Health (FenaSaúde), an organization that represents fifteen teams of operators. 40% of health plan beneficiaries. According to Vera, the decision of the STJ was balanced because it brings predictability to the sector. “The above situation could jeopardize the functioning of medium and small businesses,” he says. But his reasoning receives criticism from all sides.

“I had to hit it For manuals an examination, the cannabis was available and he underwent surgery ” Jessica Brandão, Manuela’s mother, 5, who suffers from cortical dysplasia

HIGH COST Each package of medicine consumed by Manuela costs R $ 5,000 per month (Credit: Marco Ankosqui)

“The number of incursions into the judiciary will increase to ensure that it has a right,” says Renata. “Only in court can we ensure the continuity of many treatments and, as a result, avoid deaths,” says attorney Columbano Feijó, a specialist in complementary health law and a partner at Falcon, Gail, Feijó & Sluiuzas Advocacia. That is, if it was difficult for the operators to accept payment before the deliberation, it will now get worse, as the lower courts will no doubt affect what is determined by the STJ, and therefore those who have previously been judged in a favorable manner. to the consumer, a reverse analysis can now be performed. “A person who is receiving cancer treatment, for example, and who needs a new operation or medicine quickly may not have time to wait and die,” explained Columbano Feijó. He says that now the patient is forced off the list to prove that the treatment requested by the doctor is something that will be really beneficial to him. “Health plans are allowed to deny everything that is off the list,” he says.

Clients of health plans are terrified of the insecurity that has arisen from now on. This is the case of 5-year-old Jéssica Brandão, Manuela’s mother. Since the age of two, the child has had epilepsy, and has had thirty episodes of instability a day. “My daughter hugged me and said the crisis was coming,” Jessica says. To help Manuela, Jessica had to go to court three times against the agreement. A first major examination is needed, which defines the diagnosis but is worth R $ 14 thousand. He then went to court to make Manuela available to cannabidiola, a medicine that the crisis reduced to ten cases a day. The girl has to take two vials a month, but due to the price, the treatment would be interrupted, as each unit costs R $ 2,500. The third time he had to go through a health plan was when he was diagnosed with cortical dysplasia. “We managed to have surgery with an officer,” he says. Today, epilepsy is gone, but children still need some medication, including cannabis. “It’s a phase of rejection, I’m afraid he will stop giving plans,” he said.

“When he looked at me I felt disgust in the mirror. This situation affects me socially. ”
Patricia Grunheidt, 48, has undergone bariatric surgery and is awaiting some repairs

The fear of not being able to resist treatment is a feeling shared by many people. Marketing Director Patricia Grunheidt, 48, is also in the fight. He underwent bariatric surgery in 2013 when he weighed 130 pounds. He lost 64 pounds and, like everyone else, had to undergo surgical procedures to repair the excess skin. He has been in the operating room three times because his whole body needed repairs. But all he had to do was get the paperwork in hand. ”When I looked at myself in the mirror, I was disgusted. This situation affects me socially, ”he says. Medical insurance was willing to pay for part, but not all, of the paperwork. He says he fears he will not be able to continue treatment. “I have to take care of my arms right now,” he says.

JAZATU Patrícia has been to the operating room three times to get rid of excess skin: the order in her hands (Credit: João Castellano)

Another example of the list of tax coverage is detrimental to consumers, even in situations where people are in bed, it is necessary to go to court. So says 66-year-old Ana Maria Teixeira Eland. She is battling ovarian cancer, which has become a metastasis, as well as her medical care. The agreement denied him medication, tests and immunotherapy. “I had to file a lawsuit against the plan several times,” he says. One of the surviving medicines costs two R $ 25,000 a day. “The tax role represents one more uncertainty,” he said.

The STJ deliberation took place on Wednesday, May 8, and had six votes in favor of the specific list, including that of Minister Luis Felipe Salomão. It turns out, however, that the decisions calmly taken by the magistrates are now a huge concern for people in complex health care. More: Mário de Andrad asserts that he was right, that the natural growth conditions of the anthill and the poor health of Brazilians will be maintained. In the political world, especially in the Senate, there was a backlash against the STJ’s decision. Senator Mara Gabrilli, (PSDB), for example, says the old debate in Congress and strongly affirms that the definition is bad for the entire population, especially people with disabilities, autism, and disease. “These people will be left helpless, the tax office is killing them,” says Mara. Randolfe Rodrigues says he is articulating a reaction with his senator (Rede Sustentabilidade) that he has approved a bill that will change the scenario and make the list exemplary. However, in this evolving political game, the consumer is always threatened and lost.

Dissemination

Hope for bowel cancer

In clinical trials, a new drug was able to eradicate a rare type of colon cancer in 100% of patients undergoing testing. The drug Dostarlimab was given to twelve people every three weeks for six months and the follow-up was effective for two years. This overwhelming and surprising result prevented the volunteers from performing the usual treatments: surgery, chemotherapy and radiotherapy. In addition, there was no end to the disease in any patients. The research was recently published in The New England Journal of Medicine. The remedy is an immunotherapy, a type of medication that restores the patient’s ability to recognize, control and even destroy the cells of his immune system. In addition to being a tumor with a rare mutation, it was the first time that this type of test was performed in cases of metastasis, when the disease spread throughout the body. Participants did not return the tumor. The National Agency for Health Care (Anvisa) approved the marketing of dorstarlimab in Brazil in March. But for now, it is not allowed to be used in cases of intestinal cancer, but in the endometrium. GlaxoSmithKline Pharmaceuticals, the author of the product, has not yet set its price.

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