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Hospitais privados fecham e setor quer revisão tributária e da tabela do SUS

Valor Econômico informa que um levantamento da Confederação Nacional de Saúde (CNSaúde) mostra que 560 hospitais privados foram fechados no país nos últimos oito anos — em média 70 estabelecimentos da rede particular por ano. O número representa o fechamento líquido de instituições, ou seja, a diferença entre as novas unidades e as que encerraram as operações. No mesmo período, foram extintos 34.768 leitos privados.

A estimativa do setor é que somente a reposição dos leitos fechados demandaria um investimento de R$ 28 bilhões. Para reverter esse quadro e viabilizar a retomada dos investimentos, empreendedores da área de saúde reivindicam a simplificação da carga tributária e o reajuste da tabela do Sistema Único de Saúde (SUS).

Do total de estabelecimentos fechados, 451 tinham fins lucrativos (73,3%) e 109 eram filantrópicos (26,7%). Expressiva maioria (94,7%) eram hospitais de pequeno porte, com menos de 150 leitos, localizados em cidades do interior (66,7%).

Ainda entre as unidades com atividades encerradas, 49,2% atendiam pacientes do SUS. O estudo foi feito em parceria com a Federação Brasileira de Hospitais (FBH ), reunindo dados do Ministério da Saúde, da Agência Nacional de Saúde Suplementar (ANS) e do Instituto Brasileiro de Geografia e Estatística (IBGE) no período de janeiro de 2010 a janeiro de 2019.

Os dados reunidos são indicadores relevantes para determinar os recursos na área de saúde disponíveis para a população e a capacidade de atendimento de um país ou de uma região.

No início do ano, a rede hospitalar privada contabilizava 4.267 empreendimentos. No período analisado, foram abertos 1.567 hospitais privados e fechados 2.127, a maioria no Rio de Janeiro e São Paulo. O estudo registrou que a retração do número de leitos é mais clara e acentuada do que a dos hospitais.

Havia 260.695 leitos privados no Brasil em janeiro de 2019: foram fechados 34.768 (cerca de 26% da rede), tendo sido criados 9.200 leitos em hospitais públicos no mesmo período.

O valor de R$ 28 bilhões para a recomposição de leitos na rede privada parte da estimativa de que um hospital de porte médio, com 150 leitos, gera custos de R$ 800 mil por leito ao ano. Na rede privada, a Região Sudeste concentra a maioria dos leitos (120.901), seguida pela Região Sul (58.826) e Nordeste (47.916 leitos).

O diretor-executivo da Confederação Nacional de Saúde, Bruno Sobral, diz que o estudo atesta a “morte lenta dos hospitais da rede privada”. Ele atribui o quadro, em parte, à ampliação do atendimento ambulatorial, que reduz a necessidade de hospitalização dos pacientes.

Em contrapartida, Sobral lembra que o Brasil “vai envelhecer em 30 anos o que a Europa envelheceu em 100 anos”. Nesse cenário, serão necessários mais hospitais e mais leitos.

Em julho, o IBGE divulgou a projeção de que, até 2060, o percentual de brasileiros com mais de 65 anos passará dos atuais 9,2% para 25,5%. Ou seja, um em cada quatro brasileiros será idoso.

A fatia de pessoas com mais de 65 anos alcançará 15% da população já em 2034. Os dados da Organização Mundial de Saúde (OMS) atestam o déficit de leitos no Brasil. A média sugerida pela OMS é de 2 leitos por mil habitantes na América Latina e Caribe. O Brasil já contou com 2,23 leitos por mil habitantes em 2010, mas esse número caiu para 1,95 por mil em 2019.

“Não faz sentido ficarmos abaixo da média da América Latina”, critica Sobral. A pesquisa também revelou que existe demanda para o aumento da oferta de hospitais e de leitos no setor privado. A Região Sudeste concentra a maior fatia dos estabelecimentos (41,9%) e leitos privados (46,4%), mas abriga 60,9% dos beneficiários de planos de saúde.

A rede hospitalar privada no Estado de São Paulo concentra 16,2% dos estabelecimentos e 21,7% dos leitos, mas em contrapartida, é onde se encontram 36,3% dos beneficiários de planos de saúde.

A mesma distorção é identificada no Rio de Janeiro, onde estão 7,1% dos hospitais privados e 8,6% dos leitos, mas onde vivem 11,4% dos beneficiários dos planos de saúde. Em Minais Gerais, estão 10,1% dos hospitais, 9,7% dos leitos e 10,8% dos beneficiários dos planos de saúde.

Empresários do setor atribuem o fechamento dos hospitais e a redução dos leitos, em parte, à elevada carga tributária, o que explicaria o percentual de 73,3% de unidades com fins lucrativos fechadas, já que as instituições filantrópicas contam com isenção fiscal. Outra causa de fechamento dos hospitais seria a desatualização dos valores da Tabela do SUS: o Conselho Federal de Medicina apontou uma defasagem de 80% nos valores da tabela, em média, entre 2008 e 2014.

O estudo mostrou que mais de 90% dos hospitais fechados tinham menos de 150 leitos e ficavam no interior. Com esse perfil, eles são obrigados a receber pacientes do SUS para se viabilizar, explica Bruno Sobral. Mas com a defasagem da tabela e a demora no repasse dos recursos, a maioria acaba se inviabilizando.

O estudo mostra que apenas os hospitais filantrópicos, que não pagam impostos, conseguem ampliar a capacidade de atendimento de pacientes do SUS: 92,3% atendem a rede pública.

O deputado Dr. Luiz Antônio Teixeira Júnior (PP-RJ) coordenou um grupo de trabalho na Comissão de Seguridade Social que atestou os valores irrisórios com que são remunerados os hospitais e profissionais que prestam serviços ao SUS.

“O subfinanciamento crônico do SUS tem dificultado a realização de reajustes em diversos serviços, incluindo os de média e alta complexidade”, diz o relatório produzido pelo grupo. “A desvalorização da tabela de referência gera efeitos na ponta, com o baixo interesse da iniciativa privada em participar do SUS”, completa o texto.

O relatório aprovado pela comissão no início do mês também destacou o atraso no pagamento dos honorários médicos, em parte devido ao atraso no repasse dos recursos federais ou estaduais, mesmo que as unidades federativas tenham recebido os valores pontualmente.

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