11 de janeiro de 2012

O Ministério da Saúde e a Agência Nacional de Vigilância Sanitária em conjunto com as Sociedades Médicas de Especialistas: Sociedade Brasileira de Mastologia, Sociedade Brasileira de Cirurgia Plástica, Conselho Federal de Medicina, bem como o Departamento de Proteção e Defesa do Consumidor/Ministério da Justiça, a partir das ações sanitárias realizadas pela Anvisa, dentre elas a suspensão da importação, comercialização e posteriormente o cancelamento do registro das próteses mamárias das marcas PIP e Rofil, e da necessidade de avaliação e acompanhamento das pessoas que receberam este tipo de implante, passam a informar:

1. Os portadores de próteses (PIP e Rofil) desde 2004, serão chamados para avaliação clínica nos serviços de saúde;

2. Serão elaboradas diretrizes de avaliação, diagnóstico, conduta e acompanhamento em conjunto com as sociedades médicas e Ministério da Saúde, divulgadas oportunamente;

3. O tratamento cirúrgico de substituição das próteses identificado mediante as diretrizes supracitadas será considerado reparador;

4. Até o momento, não há evidências que justifiquem a remoção e substituição preventiva das próteses em questão;

5. A qualquer tempo que sejam diagnosticadas alterações clínicas ou ruptura da prótese, o tratamento cirúrgico será de caráter reparador;

6. Os eventos adversos devem ser notificados à Anvisa, através do sitewww.anvisa.gov.br;

7. Serão realizadas reuniões periódicas deste fórum, para o acompanhamento das ações definidas nesta reunião, o que possibilitará a revisão das decisões e novas orientações.
Ministério da Saúde

Agência Nacional de Vigilância Sanitária

Departamento de Proteção e Defesa do Consumidor – MJ

Conselho Federal de Medicina

Sociedade Brasileira de Mastologia

Sociedade Brasileira de Cirurgia Plástica

Brasília, 11 de janeiro de 2012

Fonte: www.anvisa.gov.br

Doctors inevitably come into spotlight, being at the front end of health care delivery. Sometimes seen as guardian angels restoring health and life, other times, greedy minds sucking resources while they carelessly harm and kill patients to fill their wallets. After experiencing, observing, and hearing from others like me, I wonder if doctors are given more responsibility than they can handle, often attributed more aura than they deserve and frequently accused of more corruption than they are liable for.

This is my attempt to redeem them from their “divineness” and their “evil” and make expectations, speculations and skepticisms a bit more realistic. When I say doctors, I mean, a typical one in the community, having a clinical job or practice, who doesn’t do research, but reads them, member of medical societies, attends CME conferences regularly. In short, a doctor who is a consumer within the healthcare industry, which form the majority.

Doctors are trained for their skills and are not magicians. Medicine is artfully delivered science. Patients get better not because of anyone’s angelic touch or some celestial mediation, but because of treatments and interventions that are tested, tried and known to work. However, the art of delivering leaves a long lasting impression in patients’ minds. These minor details are the major differences between top and mediocre hospitals. This ends my argument about the supernatural powers that doctors are supposed or expected to have.

It is an inescapable fact that healthcare industry is more similar to other non-medical fields than it is different. However doctors are expected to play a superior role while everything else in the industry isn’t necessarily so. Healthcare is a business where workers have to be paid, professional relationships have to be maintained, the patients have to be satisfied, the corporation should run successfully. There are lots of limitations that doctors work under, making it extremely difficult if not impossible to meet all of the expectations. Held responsible for the fallacies of the healthcare system, doctors see themselves more as victims of it. There are lot of judgmental attitudes and actions that occur based on isolated events. They feel this tug and pull as they try to strike a balance between cost- cutting, defensive medicine, patient satisfaction while remaining in control of their practice and avoid an unsustainable situation personally and professionally. One patient’s angel may be another’s devil. An awesome doctor for a patient may be a colleagues nightmare and with time, it can all be reversed within no time. It just takes one bad moment to damage the reputation that has been built over years. For a doctor it is devastating, even if the factual consequences for everyone else are hardly so.

Doctors get overworked (sometimes voluntarily when they have independent practices), become victims of abuse and overuse by hospitals, employers and administrators (when employed). As a result they too become irritable, annoyed, annoying, depressed. They walk on the proverbial tight rope on each side of which are the hot oil of litigation and the fire of cost cutting that is flaring up, with the heat almost singeing their hairs. Professional competition, conflicts of interest shake and wiggle the rope, while the balancing stick has to be held on to tightly. The stick consists of professional ethics, competence, compassion and empathy to patients without getting attached to them, business and communication etiquette, time management, family, personal growth. It is indeed challenging to become a doctor who is loved by everyone around including patients, colleagues, staff, community and family especially all through their career. But if they do make it to the other end of the rope, there is a well deserved applause waiting. Mostly from self as no one else would be watching.

When it comes to business of health care, doctors are again stuck between a rock and hard place.

An integral part of the health care industry, in patients’ eyes, doctors also represent it. They are seen as accountable for any flaws in the health care system, including but not limited by the flaws in pharmaceutical industries, medico-legal system and the health insurance system. Doctors find themselves being measured with a different scale while the rest of the components that ideally have to function in parallel and in sync with doctors, go by the general rule of the industry. The medical profession requires us to empathize but not get attached to patients. It requires us to treat equally, while the insurance companies are allowed to be discriminatory in their payment. In other words, the system rewards you differently for the same treatment delivered. Doctors do not fix the price for their services, the system does. The cost of physician services vary by specialty and by procedures. Physicians cannot sell themselves to drug companies, but the companies have a strong grip on the whole health care system be it through funding research or sponsoring activities of medical societies.

In a typical private practice, overhead costs are prohibitively high (includes space, computers, electronic medical records, staffing, housekeeping, power and water supply), 70% in one place I interviewed! Moreover, the insurance companies & medicare decide the reimbursement. Again doctors are not as powerful as they appear.

Taking care of people who are suffering and making them feel better is an extremely rewarding job by itself. But there is just not enough time to do that rewarding job. If you are scheduled to see 30-40 patients in a clinic, how is it humanly possible to listen to every patient’s complete story? When our job is to care, where and when does it end?

Source: http://www.kevinmd.com/blog/2011/12/doctors-responsibility-handle.html

The following column was published on November 10, 2011  inMedical Economics.

I recently saw two patients in my primary care clinic, each with new-onset hypertension.

The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what to do next. He considered and appreciated my input but made it clear that the ultimate decision was his.

The second was an elderly gentleman in his 70s. Again, I discussed the various management approaches and then gave my opinion on what we should do. In contrast to the other patient, he said, “I want to do whatever you suggest. After all, you’re the doctor.”

As a publisher of a social media health Web site, I’ve observed closely the growth of the patient empowerment movement, facilitated by the Web making health information more accessible. According to the Pew Internet and American Life Project, 80% of Internet users go online to research their health, and this effort gives patients a greater voice in their care. Paternalistic decision making that traditionally drove the doctor-patient relationship slowly is being replaced by shared decisions. But not all patients embrace their new decision-making role.

In a recent study from the Journal of Medical Ethics, researchers interviewed more than 8,000 patients. Almost all wanted doctors to offer choices and help consider their options, but two-thirds preferred that the final medical decision to be left to the physician.

According to Farr A. Curlin, MD, an associate professor of medicine at the University of Chicago and one of the authors of the study, “the data [say] decisively that most patients don’t want to make these decisions on their own.”

There is a spectrum of how much physician involvement patients want. Some may want physicians only to suggest and inform but leave the ultimate decision to them. Others prefer doctors to have the final say.

The only way to know a patient’s preference is through a continuous relationship where that comfort level can be developed over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.

Sadly, two factors in healthcare today work against such a sustained doctor-patient relationship. One is the fragmentation of medical care. More patients are seeing not only a primary care physician (PCP) in a clinic, but also a hospitalist when admitted to a hospital, along with an array of specialists both in the hospital and the clinic. According to a New England Journal of Medicine study, Medicare beneficiaries saw an average of two primary care physicians and five specialists working in four different practices. Without knowing the patient well, each provider may differ with his or her input in the medical decision process, which can frustrate patients who may have their own ideas of how much their doctors should be involved.

Next, consider the decay of primary care itself. There is a profound shortage of PCPs, with the American College of Physicians noting that “primary care, the backbone of the nation’s healthcare system, is at grave risk of collapse.” Patients who cannot schedule timely primary care appointments go to the emergency department, where they encounter clinicians they’ve never met before. The shortage is compounded by what is shown in the results of an Annals of Internal Medicine survey, which revealed that 30% of PCPs were likely to leave the field, citing burnout from time pressures, a chaotic work pace, and little control over their work. Both the shortage and attrition of primary care providers worsen the odds of forming long-term relationships with patients.

Having known my two patients with hypertension for years, I anticipated how much physician involvement they would need to make a treatment decision and was able to tailor my approach to meet their individual expectations. During this turbulent period of healthcare reform, we cannot lose sight of the importance of a continuous relationship between doctors and patients. Otherwise, our fragmented health system and deterioration of primary care will make it challenging to provide the proper amount of guidance for patient medical decisions.

Source: http://www.kevinmd.com/blog/2011/12/guidance-patients-medical-decisions.html

The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.

Response to treatment of limited incidence and duration are accepted and deemed beneficial. Recurrence after therapy is often attributed to innate tumor aggressiveness. The cancerous process is beyond a patient’s control. Chromosomal aberrations and environmental toxins trigger carcinogenesis in undeserving people. Even tobacco abuse is blamed on unscrupulous tobacco companies, passive smoke exposure or faulty building insulation. There are few data bases comparing survival and complications for specific treatments between individual hospitals or practitioners.

Compare this regard for the vagaries of cancer incidence and treatment with the strict scrutiny of the cardiac surgeon. Despite decades of self abuse, patients expect surgical treatment of coronary artery disease to be painless, not deforming, mostly risk-free and curative. Untoward events are implicitly due to incompetence and subject to litigation. Patients not taking responsibility for modifying their lifestyle to retard disease progression is accepted as human frailty. No medical practice is subjected to the public scrutiny as cardiac surgery. Hospitals and surgeons have their reputations besmirched or praised in newspapers or magazines for supposed poor results with little consideration as to whether different patient populations are in fact comparable. In summary, the public has little tolerance for an imperfect result following open heart surgery.

Why do cardiac surgeons have to answer to a more demanding grading system? Maybe they have themselves to blame. Holding another person’s heart in your hand confers an aura of omnipotence. This high profile is accentuated by the facts that the practice is technologically intense, requires a cadre of skilled personnel and it is relatively new with rapid improvements in technique and results. All of which have occurred within the memory span of their patient population.

With this background, previously richly compensated people may have reinforced the unrealistic expectations of the public and are now facing the consequences. The current trend of decreasing surgical volume, lower reimbursement and more stringent operative criteria have chastened cardiac surgeons. Hopefully, their patients’ tolerance and expectations will be appropriately modified, not too expect inferior care, just more realistic outcomes and also understand the importance of taking control of their own risk factors.

Source: http://www.kevinmd.com/blog/2011/11/cancer-heart-disease-opposing-ways.html

These days, it is not uncommon for people to need to find a new doctor. The most common reasons include a) moving to a new city, b) dissatisfaction with your former doctor, c) your old doctor no longer accepts your new or old insurance, or d) you were diagnosed with a new medical condition and need specialized treatment.

Often, people go to their insurance company website or provider book, search for a doctor, and see a list of names in their area with contact information (and perhaps a brief biographical sketch). This narrows the choices down more than the phone book would, but now what? If insurance is not a limitation, the list of doctors to choose from will be even longer.

There is an old saying that word of mouth is the best form of advertising. This is one of the best ways to find a new doctor, provided you are getting the information from a source you know and trust. While friends and family can be good sources to ask about which doctors they use and like, it is also a very good idea to ask a friend (or friend of a friend) who works in a local hospital or health care setting. Here’s why.

First, healthcare providers know who provides good healthcare in their area. They know this because they read the reports of doctors they refer patients to, hear patient feedback on their experiences with the doctor, and may work in the same setting which allows them to have inside knowledge as to whether there are any problems with the doctor that may not be more commonly known to others.

When I needed to find an endodontist to perform a root canal last year, I first asked my regular dentist for a list of names. He gave me a list of endodontists who accepted my insurance and said all were good. Still, I wanted to base my choice on something more specific than using eenie-meenine-miney-mo. Problem is, I don’t have any friends or family members who are dentists. But I did know someone who had a relative who was a dentist in the area. I asked the person I knew about the names on the list, he asked the relative for me, and later he told me who I should see based on reputation in the dental community. The root canal worked out very well and I could not have been happier.

Another thing to do is look at the doctor’s credentials. First, check if the doctor is board certified since this gives you the highest probability that you will be provided competent specialized services. The best place to check is the website for the American Board of Medical Specialists (ABMS) which contains board certification status in 24 specialty areas. For psychology, see the American Board of Professional Psychology(ABPP), which contains board certification status in 14 different areas of psychology. Please note that there are good doctors who are not board certified and bad doctors who are board certified but you increase your chance of finding the former by choosing one who is board certified. Other credentials to look at are where the doctor went to school and completed training. This can be found by either calling the doctor’s office or doing an internet search.

An internet search is another good way to research a new doctor as you may discover news articles that a doctor was interviewed for, which may give you more confidence in the doctor’s expertise. Be careful, however, of doctor review websites because they tend to be skewed towards people who had a negative experience versus a positive experience and thus may not tell the entire story. Be sure to check the website for your state’s licensing board as this can tell you if there are any disciplinary complaints pending against the doctor.

One other idea some people have is to “interview” your potential doctor. Basically, this involves asking the doctor some important questions during an initial consultation such as how are emergencies handled, what are the after-hours policies, how can you get a prescription refill, do you actually see the doctor or a nurse practitioner, etc. Based on the answers to these types of questions and the personal feel you get based on interacting with the doctor, you can get a sense of the doctor is a right fit for you. While good rapport with the doctor is important, also consider how the office staff treats the patients. Are they friendly and courteous or do they seem to be rude and cut people short? Does there seem to be frequent infighting amongst the staff and is the doctor yelling at staff in front of patients. If so, these are bad signs. You need to deal with a competent office staff as well as a competent doctor to manage your health care needs.

One last point: If you get a letter from your doctor saying they will no longer be participating with your insurance as of a certain date due to a contract dispute, see this as a call to action. Contact the insurance company to complain and have others you know do the same who see the particular doctor. If enough pressure is brought to bear, you may not have to make a switch at all as the insurance company and doctor may then make a new agreement. This just happened to me recently, actually.

Source: http://www.kevinmd.com/blog/2011/11/tips-doctor.html

It is well known that men see doctors much less frequently than women.  The reasons are multifactorial and not all that well studied.  It’s certainly not because men are healthier than women as they die on the average seven years before women.  Clearly women are accustomed to seeing doctors at an earlier age than men for reasons relating to childbirth and birth control.  Most accept the recommendations to get an annual physical with Pap smear.

Men, on the other hand, typically don’t even think about seeing a doctor before the age of 40 unless they have a specific injury or acute illness.  Routine annual physicals for men under 40 are a hard sell.  A large percentage of men actively avoid seeing doctors even when they’re older.

According to a recent survey published in Esquire (April 2011) only 37% of men have seen a doctor in the last year.  Another third have not seen one in over a year.  Ten percent can’t even remember when they last saw a doctor.  Forty five per cent don’t have a primary physician.  The comparable number for women is 20%.  Of men in their 40’s, 20% have never had any preventative tests including prostate exams or blood tests, colonoscopy, diabetes screening and cholesterol measurements.  The questionnaire didn’t ask about blood pressure which along with blood tests are perhaps the most important screening tests.

Why are men so lax about their health?  Good studies on this issue are scarce.  The best I have seen is a Canadian study, which consisted of gathering focus groups of primary physicians in Toronto, randomly chosen, and submitting to them a standardized series of questions in interviews.  Two thirds of the physicians were men, one third women.

Their conclusions are divided into three areas.  Faulty support systems are a significant factor for men.   Men do not talk to their peers about health problems to anywhere near the extent that women do.  Women routinely compare notes with their friends about health problems, child bearing and rearing.  The only time men discuss health issues with their friends is when it is a ‘safe’ topic such as sports related injuries.  For other issues, men will be far more likely to discuss the matter with their wives or partners than anyone else.  But men are reluctant to discuss personal issues at all.  Some physicians noted that when men come, they are loathe to bring up personal problems but instead hope that the physician will ask directly.  The comments of some contributors to this blog are correct; women do indeed have to encourage their men to get medical attention.

When do men seek help?   They generally wait till they’re older with major health problems before coming on their own to see physicians.    In other words, men needed to feel very vulnerable before they seek medical attention even with the encouragement of their partners.  One positive trend is that younger men do seem to be more receptive to the encouragement of their partners to get medical advice earlier.  A common scenario is that women will berate their partners for not getting enough exercise, smoking or drinking too much and will push their guys to get medical assistance.  Some will follow through.  Probably similar to women, men are more likely to come if some of their friends have had recent illnesses, especially prostate cancer.  The physicians felt that women were far more likely to present with general complaints such as malaise whereas men waited till they had a specific complaint such as a new musculoskeletal problem or a required physical exam for employment purposes.

Barriers to seeking help can be divided into personal and systemic.  The systemic factors affect both men and women equally, especially nowadays when most women work similar hours to men.  Specific issues included long waits for appointments and long waits in the waiting room.  A common issue more embarrassing to men is being asked the reason for the appointment at the front desk.  This occurs because nearly all receptionists are women.

Concerning personal issues, the study also noted  that several participants stated that they thought the lack of a male physician was a barrier for some of their male patients, especially those in the younger age bracket:

My assistant is a woman, and I think that is sometimes a bit of a hindrance, especially talking about personal issues with trying to get an appointment for such and such a thing … I think men feel much more sensitive, especially male teenagers … very secretive about anything having to do with their genital organs.

Thus multiple issues keep men away from doctors.  Different factors influence individual men to varying degrees but there is little doubt that privacy and embarrassment factors play a role in many, especially younger men.  Men, more so than women, feel they need to be in control and are loathe to surrender their autonomy.  For most men it is more embarrassing to lose control to women and many men will not talk about sexual issues with women.  Women have much less difficulty with these issues.

This study does not quantitate what percentage of men is affected by these issues but it is clearly substantial.   Important information is still missing.   A large patient survey asking these questions directly to patients would help clarify the issue though it would still be hard to get an accurate picture.  Men are not only loathe to discuss their discomfort with women, they are also loathe to admit that the presence of women would embarrass them.  It is striking to me that men, when they do seek medical help, frequently do so for intensely personal issues such as sexual dysfunction whereas they are far less likely to present because they are concerned about more important risk factors such as hypertension or high cholesterol.  This study is rare in that it actually considers issues such as gender preferences, modesty and embarrassment.   The vast majority of medical studies prefer to view all patient physician encounters as gender neutral and to ignore a factor that nearly all patients are aware of and probably most are concerned with.

Source: http://www.kevinmd.com/blog/2011/11/embarrassment-reason-men-doctor.html

The digital age has had a deep and likely permanent effect on the patient-physician relationship. I can’t tell you how many times I’ve had physicians beg me to provide them with a way to stop their patients from Googling their symptoms and diagnosing themselves before their first office visit and much to their chagrin, my answer is always the same, “You can’t stop them. Get over it.”

The Internet acts as an enormous and easily accessible virtual research library for patients, granting them access on the one hand to quality, data-driven information and personal perspectives that can provide tremendous value and on the other hand to information that is no better than old-fashioned quackery.

But this access to information has not translated into improved interactions between patients and their physicians. It is clear to me that we all need help in rethinking how we can best work together, especially because I believe that we are still in the nascent stages of this age of disruptive new tools that delight some and threaten others. Time and time again I hear stories describing the ways in which this technology seems to be moving us backward instead of ahead:

• When Timothy B. Lee went to a dentist highly recommended on Yelp, he was asked to sign a “mutual privacy agreement” that would transfer ownership of any public commentary he might make in the future to the dentist.

• A TechDirt blog post reported that plastic surgeons have sued patients for their online negative reviews and a neurologist sued the son of a stroke victim for negative comments about the physician’s bedside manner.

Instead of pitting patient against doctor, these tools should be increasing our collaboration.

The days of the paternalistic family doctor who dispenses advice and counsel to an acquiescent, unquestioning patient are clearly over, but that needn’t be a bad thing.

Importantly, this issue features prominently in the new proposed CMS rules for accountable care organizations (ACOs) under the Affordable Care Act. An ACO is a network of doctors and hospitals that share responsibility for providing care to patients. ACOs play an important role in healthcare reform because they are intended to make providers jointly accountable for the health of their patients, providing them with strong incentives to cooperate and save money by avoiding unnecessary tests and procedures. While the focus of ACOs is collaboration at the provider level, the end game is all about the patient and increasing the quality of his or her healthcare experience.

In order for ACOs to qualify for shared savings, they must provide patient-centered care that is influenced by the patient autonomy movement. Before becoming CMS Administrator, Don Berwick wrote a provocative article in Health Affairs calling for a new definition of patient centered care as “the experience… of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care.”

In order to facilitate this shift, we need to resolve the current tension between the philosophy that idealizes the physician as always being right and patients’ newfound autonomy and access to information. We need to engage in a thoughtful discussion about how the new disruptive digital technologies can help both patients and physicians get what they need. After all, both have the same ultimate goals: good clinical outcomes and a meaningful relationship.

The good news is that these disruptive technologies can be the very mechanism we need to develop more accountable, quality-driven healthcare delivery systems because they can address some of the significant gaps in patient-physician communications that are so detrimental to the relationship. The Consumer Reports National Research Center conducted patient and provider surveys about the doctor/patient relationship and concluded that patients would get more from doctor office visits if they planned ahead, took notes during the appointments, and conducted careful online research for information. Other studies have shown that patients remember only about half of what physicians tell them during their visit and that 90 percent of patients receiving a new medication reported their physician never described the drug’s side effects. Perhaps most disturbing of all, more than 30 percent of patients were unable to name their diagnosis after being discharged.

Technology, far from being the villainous entities that so many care providers see, can actually improve a patient’s experience and address those disturbing statistics. Websites now provide patients with the tools to prepare for upcoming visits by listening to actual conversations between providers and patients that have the same diagnosis; they can organize their questions before the visit; they can record their visit using digital or mobile recording devices; and they can review the recording after the visit with caregivers and family members to better understand how they can partner with their physician’s advice.

For disruptive solutions to be successful, all of us must be willing to adapt the traditional doctor-patient relationship. Patients and physicians alike are confused and disoriented by the new digital world, even while being empowered by the knowledge they can impart. These cutting edge technologies have the potential to dramatically improve a patient’s healthcare experience, but to get there, we first have to engage in some good old fashioned talk.

Source: http://www.kevinmd.com/blog/2011/11/patients-physicians-digital-age.html

Convênios

Greve de médicos afeta cerca de 35 milhões de brasileiros

Profissionais cruzam braços em 23 estados em protesto contra planos de saúde

Saúde suplementar: o atendimento a determinados planos de saúde estará suspenso durante toda esta quarta-feira(Thinkstock)

A paralisação dos médicos nesta quarta-feira deve afetar entre 25 e 35 milhões de brasileiros – cerca de 76% do total de usuários de planos de saúde no Brasil. Os profissionais de 23 estados, além do Distrito Federal, decidiram cruzar os braços em protesto contra o valor da consulta pago pelas operadoras de saúde. Pelo menos 120.000 médicos de todas as especialidades devem suspender as atividades durante todo o dia. A categoria afirma, porém, que os atendimentos de urgência serão mantidos.

A paralisação não irá afetar os estados de Roraima, Amazonas e Rio Grande do Norte, já que as negociações com as operadoras de saúde nestes locais estão avançadas. Como cada estado teve autonomia para negociar com as operadoras, as listas de paralisações variam para cada unidade da Federação.

Em São Paulo, por exemplo, está suspenso o atendimento a 11 planos: Ameplan, Golden Cross, Green Line, Intermédica, Notre Dame, Prosaúde, Blue Life, Dix Amico, Medial, GEAP, Volkswagen. A lista completa dos planos de saúde que terão o atendimento suspenso está publicada no site do Conselho Federal de Medicina.

Contraproposta — A Fenasaúde (Federação Nacional de Saúde Suplementar), que representa os 15 maiores grupos de operadoras privadas de saúde, formalizou nesta terça-feira uma nova proposta aos médicos. Segundo nota enviada pela entidade, “o trabalho desses profissionais será classificado a partir da complexidade dos procedimentos realizados”. Pela proposta, os procedimentos médicos seriam hierarquizados em grupos e o pagamento feito de acordo com as tabelas particulares de cada plano de saúde.

Apesar da proposta da entidade, Florentino Cardoso, diretor de saúde pública da Associação Médica Brasileira (AMB), afirma que a paralisação não deixará de ocorrer. “Não há nenhum acordo firmado entre a AMB, ANS e Fenasaúde. Jamais aceitaremos essa proposta”, diz Cardoso.

Fonte:http://veja.abril.com.br/noticia/saude/medicos-brasileiros-suspendem-atendimento-a-planos-de-saude

Desde ontem, usuários de planos de saúde podem ter desconto de até 30% na mensalidade se aderirem a programas para estimular alimentação saudável, prática de exercícios, realização de exames preventivos ou mudanças de hábitos associados a doenças crônicas.

Plano de saúde cresce mais que hospital

As vantagens estão em resolução da Agência Nacional de Saúde Suplementar que acaba de entrar em vigor.

A resolução permite ainda a oferta de prêmios como mudança para um plano com maior cobertura, descontos em medicamentos ou até mesmo bens materiais sem relação com saúde.

Como a norma é facultativa, as empresas não estão obrigadas a oferecer esses benefícios. Caberá a elas também definir como irão incentivar e fiscalizar o cumprimento dessas práticas mais saudáveis.

A ANS proíbe, no entanto, que os descontos ou prêmios estejam atrelados a resultados práticos. Não poderá ser exigido, por exemplo, que alguém emagreça em decorrência das atividades propostas nem que passe a utilizar menos os serviços cobertos pelo plano de saúde.

As operadoras estão autorizadas também a fazer programas focados em grupos. Crianças com vacinação em dia, realização de exames preventivos para homens no caso de câncer da próstata ou mulheres para câncer de mama são alguns exemplos.

No caso de atividades mais difíceis de fiscalizar, como a prática de exercícios ou alimentação saudável, os planos poderão, por exemplo, indicar um profissional de saúde para fazer o acompanhamento e incentivar hábitos preventivos.

A gerente-geral de regulação assistencial da ANS, Martha Oliveira, explica que muitas operadoras já ofereciam programas de incentivo a práticas preventivas, mas a oferta de descontos atrelados a eles na mensalidade não era permitida.

Arlindo de Almeida, presidente da Abramge (Associação Brasileira de Medicina de Grupo), diz que a resolução é bem-vinda justamente porque uma das maiores dificuldades das operadoras representadas pela entidade era a baixa adesão aos programas.

Ele diz acreditar que, com a possibilidade de oferecer descontos e prêmios, a adesão aumente e mais empresas passem a trabalhar com iniciativas como essas.

A Federação Nacional de Saúde Suplementar, outra entidade que representa empresas do setor, afirma que ainda está estudando a norma e não quis se pronunciar.

Fonte:http://www1.folha.uol.com.br/cotidiano/963818-vida-saudavel-pode-garantir-desconto-em-planos-de-saude.shtml