This week I had the privilege to present the keynote address at the fourth annual supplementary health forum (Forum da Saúde Suplementar), in Rio de Janeiro, Brazil, with a focus on “The Challenge of Healthcare Efficiency” around the world.
Presented by FenaSaúde, a federation of private health plans and insurance companies that offer coverage to supplement or replace the public system, the conference was dedicated to improving the nation’s health through higher quality, better access and greater affordability of care. The organization’s president Solange Beatrix Palheiro Mendes kicked off the two-day program with a superb and comprehensive talk, emphasizing the magnitude of health challenges Brazil faces, largely the result of a years-long recession that caused 3 million of the nation’s 55 million privately insured citizens to lose their coverage.
In her remarks, she emphasized the need to integrate disparate pieces of the delivery system, expand primary care services, reduce costs and shift from a fee-from-service payment model to one that focuses on value. Her comments resonated with the problems I heard about during my trip to Australia earlier this month and at nearly a dozen U.S. conferences I attended this fall.
However, there are important differences in each nation’s approach to problems. For example, one thing that particularly stood out to me at the conference in Brazil was who attended. Not only did I see insurance company CEOs and physician leaders, but also some of the highest-ranking governmental officials. In the crowd were the nation’s newly elected Minister of Health, Mr. Gilberto Occhi, joined by the Minister of Justice, Mr. Torquato Jardim.
Bringing together these two most senior governmental leaders with a broad range of healthcare executives and experts created fertile soil for coordination and collaboration, both essential to improve a nation’s medical care. I don’t believe I have ever seen that breadth of this private-public partnership in the United States, but I would recommend that our country follow Brazil’s lead.
Throughout the conference, I listened intently to the luminaries on stage (wearing ear phones that connected me and other non-Portuguese speakers with superb translators).
In my remarks, I focused on the health challenges confronting nations around the globe. They include a rapidly aging population, the expansion of chronic disease and the rise of medical costs – often growing much faster than GDP.
Such is the case in Brazil where public system is unable to keep up with the healthcare needs of its population and the government is unable to fund the gap. Despite this challenge, I believe Brazil could be a model for the future of healthcare through traditional disruption.
Like the United States, Brazil is a sprawling nation. It’s therefore impossible to provide superior medical care in all geographies. As such, technologies as video and digital care could greatly improve the nation’s access to care while lowering costs. In addition, although the quality of medical care provided through the private supplemental plans is excellent, costs remain problematic for businesses and families. In segments where there has been price regulation, health plans are seeking innovative approaches to care delivery. I encouraged both the private and the public sectors to embrace change and move forward rapidly and together.
Later in the day, I participated in a panel discussion with a cross-section of academic, hospital, health plan and physician leaders. Our subject: What needs to happen next?
I was asked what I would do if I were responsible for the health of the Brazilian populace. I said I would encourage the formation of integrated healthcare organizations, each serving at least 50,000 members. They would be paid at the delivery-system level through capitation. They would be connected through a common, comprehensive EHR. And they would offer patients a variety of ways to obtain virtual medical care at no additional charge.
In my closing remarks, I encouraged FenaSaúde, the government and all the leaders in audience to mark the date, October 22, 2018, and begin the countdown clock that ends 5 years from now. Imagine what would happen, I said, if everyone vowed to discontinue payments to any doctor or hospital that failed by that date to meet their demands for quality, access and affordability. Admittedly, I was surprised by the applause that followed this recommendation.
I would like to thank the following people for making my visit to Rio a wonderful and educational experience: Sandro Leal Alves, FenaSaúde superintendent of regulation, Jose Cechin, the executive director, and Ana Marques, superintendent of events.
I look forward to following Brazil’s success closely in the future.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him on Twitter @RobertPearlMD.
