Public Telemedicine Policy in Brazilian Unified Health System: An Impact Analysis
Abstract
:1. Introduction
2. Theoretical Reference
2.1. Telemedicine Policy in the SUS (Single Health System)
2.2. Telemedicine Policy
2.3. Policy Instruments and Tools
3. Materials and Methods
3.1. Technique Used and Parameterization
- What is the representative impact of telemedicine on the care of the SUS population between April 2020 and April 2021?
- What is the effect of implementing telemedicine/teleconsultation in reducing hospital procedures? In what proportion?
- What is the impact of telemedicine on the population of underprivileged regions/areas?
- What are the main stakeholders’ expectations?
- What is the perception of policy participants regarding the user experience?
- Should telemedicine be maintained after the pandemic period?
3.2. Selection of Groups
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization; WHO Global Observatory for eHealth. Telemedicine: Opportunities and Developments in the Member States: Report on the Second Global Survey on eHealth; World Health Organization: Geneva, Switzerland, 2010; Available online: https://apps.who.int/iris/handle/10665/44497 (accessed on 31 May 2021).
- World Health Organization. Global Strategy on Digital Health 2020–2025; World Health Organization: Geneva, Switzerland, 2021; Available online: https://iris.who.int/bitstream/handle/10665/344249/9789240020924-eng.pdf?sequence=1 (accessed on 1 June 2021).
- Brazil. Ministry of Health. What Is Digital Health? 2020. Available online: https://www.gov.br/saude/pt-br/assuntos/saude-digital (accessed on 1 June 2021).
- Paulista Medicine Association (APM). Research Connectivity and Digital Health in the Life of the Brazilian Physician. 2020. Global Summit: Telemedicine & Digital Health, São Paulo, 10 March 2020. Available online: http://t.ly/UMLF (accessed on 30 May 2021).
- Curioso, W.H.; Coronel-Chucos, L.G.; Henríquez-Suarez, M. Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru. Int. J. Environ. Res. Public Health 2023, 20, 5980. [Google Scholar] [CrossRef] [PubMed]
- Hung, M.; Ocampo, M.; Raymond, B.; Mohajeri, A.; Lipsky, M.S. Telemedicine among Adults Living in America during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health 2023, 20, 5680. [Google Scholar] [CrossRef] [PubMed]
- Wu, T.-C.; Ho, C.-T.B. Barriers to Telemedicine Adoption during the COVID-19 Pandemic in Taiwan: Comparison of Perceived Risks by Socioeconomic Status Correlates. Int. J. Environ. Res. Public Health 2023, 20, 3504. [Google Scholar] [CrossRef] [PubMed]
- Hosseinzadeh, H.; Ratan, Z.A.; Nahar, K.; Dadich, A.; Al-Mamun, A.; Ali, S.; Niknami, M.; Verma, I.; Edwards, J.; Shnaigat, M.; et al. Telemedicine Use and the Perceived Risk of COVID-19: Patient Experience. Int. J. Environ. Res. Public Health 2023, 20, 3061. [Google Scholar] [CrossRef] [PubMed]
- Gertler, P.J.; Martinez, S.; Premand, P.; Rawlings, L.B.; Vermeersch, C.M.J. Impact Assessment in Practice, 2nd ed.; Inter-American Development Bank and World Bank: Washington, DC, USA, 2018. [Google Scholar]
- Brazil Ministry of Health. Unified Health System (SUS): Structure, Principles and How It Works. 24 November 2020. Available online: https://t.ly/yBKq (accessed on 23 May 2021).
- Brazil Constitution. Constitution of the Federative Republic of Brazil. 1988. Available online: http://t.ly/yX2x (accessed on 8 May 2021).
- Brazil. Decree No. 99,060, of 7 March 1990. Brazilian Law Collection–1990, Page 1202 Vol. 2 (Original Publication). Available online: http://t.ly/fduQ (accessed on 1 June 2021).
- BRAZIL. Law No. 8080, of 19 September 1990. Available online: http://www.planalto.gov.br/ccivil_03/leis/l8080.htm (accessed on 29 May 2021).
- Souza, R.R. The Brazilian Public Health System. In International Seminar Trends and Challenges of Health Systems in the Americas; Editora do MS: Sao Paulo, Brazil, 2002; 45p. [Google Scholar]
- Brazil Ministry of Health. Law nº 8080: 30 Years of Creation of the Unified Health System (SUS). Brasilia DF. Virtual Health Library, 18 September 2020. Available online: https://t.ly/8vH9 (accessed on 29 May 2021).
- Brazilian Institute of Geography and Statistics (IBGE). Panorama of Brazil. 2021. Available online: https://cidades.ibge.gov.br/brasil/panorama (accessed on 2 June 2021).
- Brazil Ministry of Health. Charter of the Rights of Health Users. 2011; Brasilia. Virtual Health Library Website. Available online: http://t.ly/7wjh (accessed on 1 June 2021).
- Brazil Ministry of Health. Ordinance No. 2546, of 27 October 2011. Available online: http://t.ly/QoUt (accessed on 2 June 2021).
- Federal Council of Medicine. Resolution No. 1643, of 26 August 2002. Available online: https://t.ly/HIfx (accessed on 3 June 2021).
- Federal Council of Medicine. Resolution No. 2,227, of 6 February 2019. Available online: https://t.ly/JTB8 (accessed on 3 June 2021).
- Federal Council of Medicine. Resolution No. 2228/2019 (Repeals CFM Resolution No. 2227/2019) Defines and Governs Telemedicine as a Means of Providing Medical Services Mediated by Technology and Expressly Reestablishes the Validity of Resolution No. 1643/2002. Available online: https://t.ly/cpoT (accessed on 3 June 2021).
- Brazil. Decree No. 9795, of 17 May 2019. Available online: http://www.planalto.gov.br/ccivil_03/_ato2019-2022/2019/decreto/D9795.htm (accessed on 3 June 2021).
- Brazil. Law No. 13,989, of 15 April 2020. Provides for Using Telemedicine during the Crisis Caused by the Coronavirus (SARS-CoV-2). Available online: http://t.ly/Ev0m (accessed on 3 June 2021).
- Celes, R.S. Telehealth as a State Response Strategy: Systematic Review. Rev Panama Salud Publica. n 42, p. 1–8, 2018. Available online: https://iris.paho.org/bitstream/handle/10665.2/49154/v42e842018.pdf?sequence=1&isAllowed=y (accessed on 16 September 2021).
- Caetano, R.; Silva, A.B.; Guedes, A.C.; Paiva, C.C.; Ribeiro, G.D.; Santos, D.L.; Silva, R.M. Challenges and Opportunities for Telehealth during the COVID-19 Pandemic: A Reflection on Spaces and Initiatives in the Brazilian Context. Caderno de Saúde Pública, Rio de Janeiro, v. 36, n. 5, p. 1–16, May 2020. Available online: http://cadernos.ensp.fiocruz.br/static//arquivo/1678-4464-csp-36-05-e00088920.pdf (accessed on 12 October 2021).
- Celuppi, I.C.; Lima, G.D.; Rossi, E.; Wazlawick, R.S.; Dalmarco, E.M. An analysis of the Development of Digital Technologies in Health to Face COVID-19 in Brazil and in the World. Caderno de Saúde Pública Rio de Janeiro, v. 37, n. 3, p. 1–12, March 2021. Available online: http://cadernos.ensp.fiocruz.br/static//arquivo/1678-4464-csp-37-03-e00243220.pdf (accessed on 12 October 2021).
- Freitas, B.A.C.d.; Prado, M.R.M.C.D.; Toledo, L.V.; Fialho, W.L.; Ayres, L.F.A.; Almeida, S.L.; Silva, T.C.S.E.; Brito, M.P.; Siman, A.G.; Oliveira, D.M.D. Analysis of the services provided by telehealth-COVID in a municipality in Minas Gerais. Rev. Bras. Epidemiol. 2021, 24, E210036. Available online: https://t.ly/Sl31 (accessed on 3 December 2021). [CrossRef] [PubMed]
- Brazil Ministry of Health. National Health Plan (PNS) 2020–2023. Brasilia DF. 2020. Available online: https://t.ly/6Qat (accessed on 20 May 2021).
- Brazil Ministry of Economy. Secretary. Farm Special. Pluriannual Plan (PPA) 2020–2023: Intermediate Results. Brasilia DF. 2021. Available online: https://t.ly/WoMH (accessed on 25 May 2021).
- Brazil Ministry of Health. Connect SUS: RNDS, 2021. Available online: https://rnds.saude.gov.br/ (accessed on 3 June 2021).
- Brazil Ministry of Health. Minister’s Office. Ordinance no. 467, of 20 March 2020. Brasília, 2020. Available online: https://www.in.gov.br/en/web/dou/-/portaria-n-467-de-20-de-marco-de-2020-249312996 (accessed on 10 May 2021).
- Brazil Ministry of Health (MS). TeleSUS. Secretariat of Primary Health Care, 2020. Available online: https://aps.saude.gov.br/ape/corona/telesus (accessed on 26 May 2021).
- Brazil Ministry of Health. Executive Secretary. Department of Informatics of the SUS. Digital Health Strategy for Brazil 2020–2028 [Electronic Resource]/Ministry of Health, Executive Secretariat, Department of Informatics of the SUS. Brasilia: Ministry of Health, 2020. 128p. Available online: https://t.ly/Yl3x (accessed on 13 May 2021).
- Brazil. Civil House of the Presidency of the Republic: National Institute of Information Technology (ITI). Digital Revenue: Understand What It Is, How It Works, and How to Validate It. 22 July 2020. Available online: http://t.ly/gmZ1 (accessed on 7 May 2021).
- Brazil. Ministry of Education: Brazilian Company of Hospital Services—Ebserh. 25 May 2021. About Federal University Hospitals. Available online: https://t.ly/MYEI (accessed on 18 January 2022).
- Mélo, C.B.; Farias, G.B.; Ramalho, H.V.B.; Dos Santos, J.M.G.; Da Rocha, T.T.; Gonçalves, E.J.G.; De Moura, R.B.B.; Laureano, C.S. Teleconsultation at SUS during the COVID-19 Pandemic in Brazil. Res. Soc. Dev. 2021, 10. Available online: https://rsdjournal.org/index.php/rsd/article/download/17675/15755/222557 (accessed on 15 January 2022).
- Brazilian Institute of Geography and Statistics (IBGE). National Health Survey 2019: Primary Health Care and Anthropometric Information; IBGE: Work and Income Coordination; IBGE: Rio de Janeiro, Brazil, 2020; 66p.
- Brazilian Institute of Geography and Statistics (IBGE). Household Budget Survey 2017–2018: Expenditure Profile in Brazil; IBGE/Work and Income Coordination: Rio de Janeiro, Brazil, 2020; 110p. Available online: http://t.ly/pyaz (accessed on 6 June 2021).
- Brazilian Institute of Geography and Statistics (IBGE). Continuous National Household Sample Survey 2019. 2020. Available online: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101707_informativo.pdf (accessed on 20 May 2021).
- CETIC.br. ICT In Health 2021: Survey on the Use of Information and Communication Technologies in Brazilian Healthcare Facilities; Internet Management Committee in Brazil, Ponto BR Information and Coordination Center: São Paulo, Brazil, 2021; 316p, Available online: https://t.ly/QF56 (accessed on 26 January 2022).
- Brazil. Ministry of Health. Teleservice Becomes an Alternative during the COVID-19 Crisis. 26 May 2021. Available online: http://t.ly/k3Yu (accessed on 26 May 2021).
- Brazil. Ministry of Education: Brazilian Company of Hospital Services—Ebserh. 24 May 2021. More than 12,000 Teleservices Have Already Been Carried Out by Nutes UFPE, the Digital Health Unit of HC-UFPE/Ebserh, during the COVID-19 Pandemic. Available online: http://t.ly/9uyM (accessed on 26 May 2021).
- Brazil. Ministry of Education: Brazilian Company of Hospital Services—Ebserh. 20 May 2021. Teleattendance Is Established as a Viable Alternative for Appointments during the Pandemic. Available online: https://t.ly/ns9m (accessed on 26 May 2021).
- Brazil. Ministry of Education: Brazilian Company of Hospital Services—Ebserh. 9 June 2020. Population Approves Telemedicine Service Created by HULW during the Pandemic. Available online: https://t.ly/HWnh (accessed on 26 May 2021).
- Federal University of Sergipe (UFS). 21 May 2020. HU Implements a Teleorientation Service during a Pandemic. Available online: https://t.ly/WkBC (accessed on 29 May 2021).
- Bahia Secretary of Health (SESBA). 24 March 2020. Available online: https://t.ly/ehvd (accessed on 18 January 2022).
- Mota, S.C.; De Oliveira, A.R.V.; De Vasconcelos, A.C. Efficiency of Assistance in University Hospitals Managed by EBSERH. In Proceedings of the XX USP International Conference in Accounting, São Paulo, Brazil, 29–31 July 2020. [Google Scholar]
- Brazil Ministry of Health. More than 2 Million People Have Already Used TeleSUS Services. 14 April 2020. Available online: http://t.ly/rZiz (accessed on 26 May 2021).
- Brazil. Ministry of Health TeleSUS Has Served More than 73 Million Brazilians. 23 June 2020. Available online: http://t.ly/SPf4 (accessed on 20 May 2021).
- Rossi, L. Fear of the Coronavirus Drives Telemedicine in Brazil. 22 January 2021. Capterra. Available online: https://www.capterra.com.br/blog/1911/telemedicina-brasil (accessed on 26 May 2021).
- National Telecommunications Agency (ANATEL). Analytical Report on the Impact of the COVID-19 Pandemic on the Telecommunications Sector in Brazil. 2021; Brasilia: 2nd ed. Available online: https://t.ly/kkvD (accessed on 20 January 2022).
- Silva, T.C.; Anghinoni, L.; Chagas, C.P.d.; Zhao, L.; Tabak, B.M. Analysis of the Effectiveness of Public Health Measures on COVID-19 Transmission. Int. J. Environ. Res. Public Health 2023, 20, 6758. [Google Scholar] [CrossRef] [PubMed]
- Tabak, B.M.; Froner, M.B.; Corrêa, R.S.; Silva, T.C. The Intersection of Health Literacy and Public Health: A Machine Learning-Enhanced Bibliometric Investigation. Int. J. Environ. Res. Public Health 2023, 20, 6951. [Google Scholar] [CrossRef] [PubMed]
- Tabak, B.M. The Economic Analysis of Law—Legislative Propositions and Public Policies. Rev. Informação Legis. 2015, 52, 321–323. [Google Scholar]
Decision Sphere | Deliberative Collegiate | Manager | Intermanagement Commissions | Representatives of Managers (*) |
---|---|---|---|---|
Federal | National Council (CNS) | Ministry of Health (MS) | Tripartite Commission (CIT) | CONASS CONASEMS |
State | State Council (CES) | State Secretariats (SES) | Bipartite Commission (CIB) | |
Municipal | City Council (CMS) | Municipal Secretariats (SMS) | Bipartite Commission (CIB) | COSEMS |
Indicators | Description | Measurement |
---|---|---|
Infrastructure | Availability of access links and equipment by the population | Number of hits; quality of the communication link; equipment X population |
Process | The average population rate of use | Number of teleconsultations by region/state |
Result (Clinical Care) | Primary care service Admissions Diagnostics | Number of primary and specialized consultations per person and by region/state: general, before and during the pandemic, and by teleconsultation |
Economic | Cost of teleconsultation Cost–benefit impact | The total cost of teleconsultation versus the cost of face-to-face consultation |
Complementary Data | Evolution of the coronavirus in Brazil population data | Number of cases per month; population growth forecast |
Encouraged Group | Group Not (or Little) Encouraged | Impact | |
---|---|---|---|
% of Participation = 87.5% MD Y = 88 | % of Participation = 50% MD Y = 32 | Δ% Participation = 37.5% ΔY = 56 LATE = 56/0.375 = 149.33 | |
Never | |||
Participates if encouraged | |||
Always |
Group 1 | Group 2 | |||||
---|---|---|---|---|---|---|
P/Month | By Inhabitant | P/Month | By Inhabitant | Difference | LATE | |
The General Average of AIH * Approved from 2020 to 2021 | 15,266 | 0.00236 | 8670 | 0.00280 | −0.00045 | −0.0012 |
General Average Outpatient Care for 2020 and 2021 | 1,824,183 | 0.28342 | 1,356,003 | 0.35253 | −0.06911 | −0.1843 |
Participation Index | 87.5% | 50% | 37.5% | --- |
Teleconsultation | ||||
---|---|---|---|---|
2020–2021 | 301010307 * | 301010315 ** | ||
GROUP 1 | 1319 | BRL 13,190.00 | 12,739 | BRL 80,255.70 |
GROUP 2 | 271 | BRL 2710.00 | 646 | BRL 4069.80 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Oliveira, A.M.d.; Valadão, M.A.P.; Tabak, B.M. Public Telemedicine Policy in Brazilian Unified Health System: An Impact Analysis. Int. J. Environ. Res. Public Health 2024, 21, 657. https://doi.org/10.3390/ijerph21060657
Oliveira AMd, Valadão MAP, Tabak BM. Public Telemedicine Policy in Brazilian Unified Health System: An Impact Analysis. International Journal of Environmental Research and Public Health. 2024; 21(6):657. https://doi.org/10.3390/ijerph21060657
Chicago/Turabian StyleOliveira, Angela Maria de, Marcos Aurélio Pereira Valadão, and Benjamin Miranda Tabak. 2024. "Public Telemedicine Policy in Brazilian Unified Health System: An Impact Analysis" International Journal of Environmental Research and Public Health 21, no. 6: 657. https://doi.org/10.3390/ijerph21060657