This is especially the case in Rio Grande do Sul (RS), where the Federation of Rio Grande do Sul Health Establishment Workers (Federação dos Empregados em Estabelecimentos de Saúde do Rio Grande do Sul – FEESSERS) represents workers in the sector.
In Brazil, a government that came to power in a political coup is engaged in a campaign to rollback social rights. It has no commitment to the public in general. President Michel Temer has frozen health expenditure for the next 20 years and therefore, as from 2018, the maximum expenditure on health will be the same as the previous year plus inflation.
Private sector companies will be the beneficiaries. They have started signing up new clients for their health care schemes. However, the public is cautious and the high rate of unemployment (12.06% in the country, 27.3% in RS) has led many families to return to the SUS.
Meanwhile, the government’s campaign to dismantle the SUS means this whittled down public service will not be able to meet the demand placed on it by this increase in numbers.
The health minister, Ricardo Barros, has called for “the creation of a more popular Health Plan, with access to fewer services than allowed for under the minimum obligatory coverage determined by the National Supplementary Health Agency (ANS), with less cost to consumers, who should also make a financial contribution to the SUS”. This means the privatisation of the universal health system and the end of free health care for Brazilians.
More than 3,000 private health establishments (bank health care schemes, doctors’ cooperatives, dentists’ cooperatives, supplementary programmes, clinics, laboratories, etc.) are registered in Rio Grande do Sul.
In Brazil, 75% of patients are treated at “Santa Casas” and other philanthropic hospitals. The administration of some philanthropic hospitals and health centres have been outsourced to fourth parties (quarteirizada).
This proliferation of private institutions is taking place at the same time as public health schemes and philanthropic institutions, such as the Santa Casa hospitals, are being brought down. In Rio Grande do Sul, Governor José Ivo Sartori followed the example set by the federal government when he took office in 2015. His first measure in the health field was to cancel a programme of incentives for hospitals (IHOSP) that covered building works, the purchase of equipment and the modernisation of structures, and delay the transfer of federal and state funding.
Another aggravating factor is the recent amendment to Act 8080 of 1990, which deals with the organisation and operation of health services. In 2015, Act 13.097 amended the 1990 Act to authorise the operation and purchase by foreign capital of hospitals in general, including philanthropic institutions.
In addition to allowing transnational companies to enter the private health sector, this amendment opened the way for the unprecedented and large-scale privatisation of the philanthropic sector. The combined effect of these two aspects of the new law is increasing commercialisation of health care.
Some philanthropic hospitals have been bought and there has been a snowball effect. Working conditions have deteriorated for health professionals. Employers have further increased the pressure and dismissed staff but “productivity” targets remain the same, with fewer workers.
There has been a reduction in funding and administrators have started to delay the payment of wages (in some cases, payments to workers were already in arrears) and stop payment of holiday pay, 13th month wage and social security charges (e.g. FGTS). Managers have also started to systematically bully workers and erode professional standards.
In addition, establishments have started to reduce the number of beds and cut admission vacancies, health centres, complex medical tests, elective operations and even closed neonatal intensive care units. How have health sector workers fared amid this turmoil? They are being subject to increasing levels of harassment and disruption of their personal and family lives. However, they are doing their best to make sure the work gets done and they fulfil their duties to the population.
There has been no lack of action. Yet, the Governor José Ivo Sartori, has never taken the trouble to meet workers or listen to what they have to say about the current crisis. Unions have held many meetings, some with employer organisations. They have also promoted the creation of discussion forums in parliament, organised marches and distributed leaflets explaining the situation and called for strike action. Nothing has had any impact on the governor. As a result, more than 100,000 health sector workers are living in a state of uncertainty.
The scrapping of public and philanthropic services is part of a strategy to privatise hospitals. And despite the current economic and political crisis in Brazil, international private groups such as United Health/Amil and Rede D'or are significantly increasing their investments in the country; preparing for the dismantling of the universally accessible national health system, the SUS.
This is the sad picture of health in Brazil and Rio Grande do Sul. The prospects for the next few years are not encouraging but FEESSERS and affiliated unions will remain at the side of workers and the people as a whole. We will call the authorities to account and demand respect for workers' rights, including the timely payment of wages and national insurance contributions. And we will not waver in demanding the provision of health for all in Brazil.
By Milton Kempfer, President of the Federação dos Empregados em Estabelecimentos de Saúde do Rio Grande do Sul – FEESSERS