Healthcare and Competitiveness in Brazil: The Policy Connection

A healthy population and the resulting social development are fundamental to boosting a nation’s level of productivity and advancing its global competitiveness. A nation aspiring to be a global leader must implement health standards that encourage the productivity of its citizens. In doing so, it must create a public policy environment that both supports timely access to quality healthcare and fosters continued medical innovation. This is the challenge currently facing Brazil.

The agenda of the government following the October elections presents a true opportunity to connect competitiveness and healthcare in a forward-looking public policy program. All businesses must educate and work with our new leaders to ensure they view good healthcare policy as essential for the future of the nation.

To appreciate why this is so critical, it is important to understand the current healthcare environment. Today, the Brazilian government and its citizens are combating the high prevalence of some deadly and costly diseases, including HIV/AIDS, tuberculosis and diabetes. Regrettably, our investment in healthcare is not enough to meet the challenges they pose.

Fiocruz (Oswaldo Cruz Foundation) recently released data comparing Brazil’s per person public health expenditures with that of other South American countries. In Argentina and Uruguay, the amount spent per citizen is US$ 362 and US$ 304, respectively. In Brazil, the amount is just US$ 212 per citizen. This is approximately 10% of what is spent per year, per citizen for public health in Europe, Japan and Canada.

How Brazil responds in the health policy arena – for example, balancing the need to ensure patient access to lifesaving technologies while controlling healthcare costs – will help determine our future as a global leader.

The depth of Brazil’s problem can be illustrated with a few examples. According to data from the Brazilian Ministry of Health, an estimated 600,000 Brazilians live with HIV today. The mortality rate in 2003, the last year for which statistics are available, was 2% higher than in 2002, and the incidence is increasing among women.

Today, all Brazilian citizens can have access to monitoring tests and therapeutic medication supplied by the government. They go to the public services and, according to clinical criteria, receive the necessary treatment. This is not sufficient. The early detection of disease is a key component to improving public health and controlling healthcare costs.

The Brazilian STD/AIDS Program is prepared to assist approximately 200,000 people, according to the last AIDS Epidemic Update by UNAIDS in December 2005. The government touts the program as a model for other developing countries, and while it has taken a tremendous step toward reducing the number of deaths, there is still a considerable way to go. Specifically, the program could place more focus on prevention. Our government must recognize the importance of preventing AIDS (and all diseases), which is critical to protecting public health. It is well established that measures to prevent disease can dramatically reduce healthcare costs.

Tuberculosis (TB) provides another clear illustration of how timely patient access to diagnostics tests and treatments can have a dramatic effect on health outcomes. A highly prevalent disease, TB has infected an estimated 50 million Brazilians with approximately 100,000 new cases and 6,000 deaths occuring each year. Of significance, an additional 25.5% of Brazilian patients with HIV/AIDS are co-infected with tuberculosis, which often goes undiagnosed.

Brazil, in line with the international community, aims to detect 70% of tuberculosis cases and achieve an 85% cure rate. To achieve this goal, the government supplies diagnostic tests and medication for TB. However, a lack of coordination between the federal government, the states and the cities has impeded progress, and the goal is not being achieved. Today, Brazil ranks 15th among the 22 countries responsible for 80% of the total TB cases worldwide.

Another disease burdening Brazil is diabetes, which affects 4.6 million of its citizens. If not detected early, properly monitored and managed, diabetes can lead to several deadly and debilitating complications, undoubtedly costing the country more than the price of prevention. Again, effective diabetes management can only be achieved with timely patient access to appropriate diagnostic tests and blood glucose monitoring technologies.

The prevalence of these three diseases impacts the global competitiveness of Brazil. Access to medical tests and treatments is central to effectively detecting, managing, and treating some of our country’s most socially and economically burdensome conditions. Today, it is not uncommon to find Brazilians at-risk or infected with these diseases filing legal petitions seeking the right to receive either conventional or new technology treatments. While they generally are granted that right, it is appropriate to question whether this is the most efficient way to ensure patient access to quality care – especially if the Brazilian government wants to raise productivity and successfully compete in the global arena. I would argue that it is not.

The Brazilian Constitution states that "Health is a citizen right and an obligation of the State." This broad statement allows for a variety of interpretations, but most would agree that today it is not a reality for all Brazilians. It is time for the Brazilian government to work with patients, healthcare institutions, innovators and other stakeholders to design and implement public policies that will result in all citizens having access to the latest and most effective medical tests and treatments, thereby creating the environment essential to a productive population and economic growth.

According to the BRIC thesis – a 2003 analysis by Goldman Sachs – Brazil is forecast to join Russia, India and China as one of the world’s most dominant economies by mid-century. However, its capacity to do so may be hindered by its healthcare system. The thesis says that “institutions affect the ‘efficiency’ of an economy much in the same way as technology does: more efficient institutions allow an economy to produce the same output with fewer inputs: Bad institutions lower incentives to invest, to work and to save. ‘Institutions’ in this broad sense include the legal system, functioning markets, health and education systems, financial institutions and the government bureaucracy.” While the Brazilian democratic institutions are more robust than those of some other BRIC countries, Brazil has not been growing economically in line with thesis projections. We need to increase productivity to stimulate the economy and create competitiveness. Good healthcare is fundamental to increased productivity.

Brazil has joined 191 other countries in signing the Millennium Declaration, approved by the United Nations in September 2000. Three of the Declaration’s eight major development goals are healthcare-related: reducing child mortality; improving maternal health; and combating HIV/AIDS, malaria and other diseases. We have an opportunity to focus on these problems and implement policies that stimulate productivity. By studying the impact of disease on national health in comparison with other countries, we will have an opportunity to better understand the linkage between early detection of disease, timely delivery of quality healthcare, and the competitiveness of our people and nation.

Brazil must continue to prosper and compete globally. Investments in healthcare can help our country compete globally and, at the same time, better the lives of our citizens. Progress in this area will not come easy, but that should not dissuade us from tackling these important issues. Brazil’s future competitiveness hinges upon our ability to face these problems today. Healthcare issues cannot wait anymore, as the world does not wait.
 

Geraldo Barbosa is President, South Latin America for BD (Becton, Dickinson & Company), a medical technology company that manufacturers and sells a broad range of medical suppplies, devices, laboratory equipment and diagnostic products. He also serves on the AmCham Board of Directors, and is a member of the National Quality Foundation (FNQ) and the Brazil Competitive Movement (MBC).

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