The Medical Demography survey, launched today (8) by the Faculty of Medicine of the University of São Paulo (USP) in partnership with the Brazilian Medical Association, shows that, despite the significant growth in the number of physicians in recent years, inequality in access to medicine in Brazil. According to the survey, in 2013, there were 357.5 thousand professionals, and, in 2023, it reached 562.2 thousand. With this, Brazil has an index of 2.6 physicians per group of 1,000 inhabitants. The number is still below the average of 3.36 physicians per inhabitant among countries assessed by the Organization for Economic Cooperation and Development (OECD). However, it is similar to countries such as the United States (2.64) and Canada (2.77). Regional differences There are inequalities both in the regional division and in the performance of public and private health networks. In the North, the index is 1.45 doctors for each group of 1 thousand inhabitants, and in the Northeast, 1.93. While in the Southeast, the ratio is 3.39 physicians per 1,000 inhabitants. In the Federal District, the index reaches 5.53 and in Vitória, in Espírito Santo, it reaches 14.49. The professor of the Department of Preventive Medicine at USP, Mário Scheffer, who coordinated the study, pointed out that there is an imbalance in the number of professionals working in the private and public health network. “If I had one word to sum up the offer of physicians in Brazil, I would say that inequality is the hallmark. We are talking about quantitative increase, but inequality is persistent, ”he says. Citing data from the previous study that, according to the researcher, remain, he pointed out that only 21.5% of doctors work exclusively in the Unified Health System (SUS). “But 10% of them are resident physicians who are almost compulsorily there because their training is at the SUS”, he added. They work only in hospitals and private clinics, 28.3% of doctors and 50.2% work in both networks. Few consultations This asymmetry is reflected, according to Scheffer, in the effective access to health. Based on the analysis of the 660 million medical consultations carried out in 2019, the study points out that the Brazilian population performs, on average, 3.1 consultations per year. The value drops to 2.3 among SUS users and stands at 3.3 for those with health insurance. The rate is lower than the average for OECD countries, of 6.8 consultations per inhabitant per year, and for countries such as Germany (9.8) and Canada (6.6). “We see that, despite having a reasonable number of doctors, we have a number of consultations that are completely lower than in other countries that have a number of doctors similar to that of Brazil. This is because we have this overlapping of inequalities, it is not just the case of a regional distribution. Also this distribution of doctors in the public sector and in the private sector, with this dramatic consequence of efficiency”, analyzes the researcher from the Federal University of Rio de Janeiro Ligia Bahia, who also participated in the study. Therefore, Ligia Bahia states that it is necessary to expand the SUS network as a way of guaranteeing access to health. “We need to have a much less privatized health system”, she emphasizes. Allocation policies Scheffer defended the adoption of policies, such as the Mais Médicos program, which promote the redistribution of professionals across the country. According to him, the opening of medical courses in the interior of the country was not enough to take professionals to locations outside the major economic centers. “This is an example of a policy that must continue, but also consider the transformations that are taking place,” he said. For the study coordinator, it is necessary to plan the distribution of professionals across different regions. “One of the issues is precisely what the doctor’s profile is, the qualifications and the appropriate training to fill these jobs where there is still a shortage of doctors. In this sense, doctor allocation programs are important.” The professor at the State University of Rio de Janeiro Mário Dal Poz, who also participated in the research, believes that it is necessary to identify the incentives that will make doctors settle, at least for part of their career, in more remote regions. “Doctors react to financial and non-financial incentives like any other professional. So, the question of offering adequate sets of incentives: remuneration and a series of others that can be considered for the positions you want [levar os profissionais]”, it says. According to the expert, some countries have successful experiences in this regard, by establishing careers for these professionals to also work in more remote areas. “As a public policy, you have very cool experiences that work in Canada, Australia and several other countries where you encourage these doctors, create conditions for them to be there for a while and then these doctors evolve – they get married, have children – and they have other opportunities to go to other places”, he commented.
Agência Brasil
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