The Future of Brazilian Health Systems

Innovation is not an option – it is a REALITY  

There is a lot of uncertainty at the moment, but a fact is proven, we will have to do more with less.

Where are we now?

Current health systems are essentially healthcare systems, built in the middle of the last century. Although there has been tremendous progress in diagnosis and treatment, care delivery has not changed much structurally. It is still provided between brick and mortar walls where people who are sick or seriously ill are seen and treated by highly trained people. This system was not designed to deal with the huge growth of chronic diseases, which now accounts for well over 80% of all health spending.

Currently, the daily pressures in society, leave little time for the individual to look at their health, the current health system has in recent years become a hospital-centered system, functioning as a “one stop shop” model, the care doctor or The family doctor was practically replaced by a few hours of waiting in the emergency room.

The increasingly general medical training, causing institutions to invest in high technology and diversity of labor in their technical staff, without considering their own demand or even the profile of their portfolios.

What changes are coming?

Everything will be different going forward. We learned hard from this crisis, but we need to start looking at healthcare from the perspective of users. Understand the social factors that affect chronic conditions so that they can play a more active role in management. Engage with health preservation and not only with the care of the disease, supporting and training them in relation to sleep, food, smoking, drinking and exercise, as well as all aspects of the proper management of their health condition. The goal is to keep them proactively well, rather than reacting when they get sick.

It is not just telling them what to do (most people who smoke know this is bad for their health), but really engaging them by providing smart technology so they can be monitored closely. They can use devices that constantly measure levels of heart rate, blood pressure, breathing, weight or activity. This data can be transmitted from the device or application to a smartphone and processed by algorithms that show how their health is evolving. The patterns created can show that intervention is needed or that that person may, for example, be at risk. Both the person and the remote care team can monitor their health. “Care centers” can act as a flight control center, observing the health of the population, based on a combination of user flow information and health records that they maintain. These hubs can help users whose data indicates the need for support, either through a two-way video consultation or in-person evaluation.

All this cultural change will contribute to the balance and sustainability of the public and private health system, changing in some lines of care the form and model of remuneration, that is, clinical outcome is of great importance in this new model.

What will the future look like?

Our vision of the future is one in which, for example, a general practitioner uses the tablet’s ultrasound to make a film of a user’s throbbing heart. When irregularities are observed, the general practitioner shares this with a cardiologist to assess and define a care plan. It is not necessary to make an appointment in weeks or months – the problem can be solved in real time. That is what hosts us to book flights, make our finances or shop online.

It is a world in which someone with a chronic condition has all their vital data passed on to their care team, who will likely know before the patient that someone needs to intervene to provide support or treatment.

Patients will still need specialists with specialized knowledge, but the patient and the specialist do not need to be in the same space at the same time. A connected service network means that multiple experts can review the case simultaneously. This would allow early diagnosis of health problems, with constant monitoring before they become more serious.

With the growth of remote monitoring technologies, in addition to conventional user registries, there will be a greater emphasis on collecting and analyzing large amounts of data. This will support more personalized medicines, where the treatment will be individually adapted for everyone.

Hospitals will be smaller, more integrated, and more effective at other levels of care.

Hospitals will be used for patients with greater accuracy. Integrated patient care, with an emphasis on prevention and well-being, less invasive procedures and advances in research will ultimately reduce the demand for hospitalizations. Redundancy will be eliminated with the availability of specialized areas of medicine within a certain radius, but not necessarily in each unit of the system.

Today, the hospital is the cost center. In the future it should be the last place to be. The focus needs to be on population health, primary care, and ambulatory care. There will certainly be a greater focus on well-being. Obviously, it is cheaper to keep a person healthy than to care for them when they are sick.

We need to incorporate health preservation into our daily thinking. The new health profession will be “Consultant in Strategic Health and Social Welfare Planning”. This professional will be responsible for a group of the population where environments will be created that will provide much more support to team service, much more collaborative. Doctors lead, but do not dominate. Health care will be vertically integrated and not all in one place. And they will be delivered at home, in a retail store, at their workplace, almost anywhere.

Technology / data intensity will be crucial

IT is seen as “the facilitator”. Telehealth, home monitoring systems, tests at the point of care, EMR and data management will have an impact on infrastructure and physical space.

In the coming years, Telehealth will be much more integrated to routine care, in the doctor’s office, clinic and hospital. It is not a question of if, but when. We must get there to survive.

Many systems around the world have already started to make changes that will make them more competitive, regardless of the impacts of the pandemic. The consensus is that health, as it is practiced today, is not fiscally sustainable. There must be, and there certainly will be, transformative changes in the Brazilian health system.

There will be a new appreciation of personal responsibility. It is my health, not yours. We must get there. I hope there are opportunities for innovative and courageous methodologies that can lead to best practices.

These will be normal practices for the post-pandemic.

Well-planned health care boosts the economy and should become a strategic priority for public policies.

Não podemos pensar de forma linear em um mundo exponencial.
Creating the New Normal The Post-Pandemic Health System Reform

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