FINANCIAL SUSTAINABILITY IN THE BRAZILIAN PUBLIC HEALTH SYSTEM (SUS): THE EVOLUTION OF MEDICAL INFLATION AND ITS IMPACTS ON HIGH-COMPLEXITY PROCEDURES

Abstract

The financial shortfall in reimbursement for highly complex hospital procedures within the Brazilian Unified Health System (SUS) compromises the economic sustainability of service-providing institutions. The lack of adequate adjustments to the SUS fee schedule in response to variations in medical-hospital costs, as measured by the Medical-Hospital Cost Variation Index (VCMH/IESS), generates financial losses and impacts the quality of care. The objective of this research was to analyze the discrepancy between the amounts paid by the SUS and the evolution of healthcare costs from 2013 to 2023. To this end, the 10 most frequently performed highly complex hospital procedures in the SUS were identified, their values ​​were compared with the variation in the VCMH/IESS, and the resulting financial shortfall was measured. This study used quantitative data analysis from the Decentralized Hospital Information System (SIH/D2) and the SUS Table Management System, analyzed using Microsoft Excel 365. The results showed a 70.01% shortfall in 2023, with an accumulated deficit of R$ 3.71 billion for 2,197,733 procedures performed. The accumulated medical inflation of 383.34% contrasted with adjustments of only 30.71%. The findings demonstrate structural unsustainability that compromises the viability of providers and underscores the urgent need to reformulate the financing policy, with the implementation of indexation mechanisms based on sectoral indices to guarantee economic balance and the quality of services provided by the SUS.