The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017

Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (þ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.

Shortage in residents of internal medicine and current status of Korean medical system

The shortage of internal medicine residents depict the contradictions and perversions in Korean medical system. Internal medicine is the foundation of medicine and the fact it serves as the most essential medical services for the people adds severe gravity to the issue. The fundamental problem derives from the contradictions in health insurance system. In fact, the poor medical fee and the failure of medical delivery system are the core drawbacks to the current crisis. Unless above matters are addressed to draw a constructive resolution, it is an undeniable fact that this may become a serious threat to the national health system and people's wellbeing.

Comparative study on medical fees: caesarean section, cataract, and appendectomy surgeries among OECD countries

The question has been raised whether the medical fee schedule is very low in Korea. However, studies that empirically address this matter on a national scale are rare. This study attempted to determine the level of Korea's medical fees for caesarean section (C-section), cataract, and appendectomy surgeries by comparing and analyzing them with other Organization for Economic Cooperation and Development (OECD) countries' medical cost data obtained from other studies. There are two ways to compare the level of medical fees: one is a direct comparison, which obtains each country's medical fee schedule and compares them with each other. Another is indirect comparison, a method which compares data such as physician income. For direct comparison, fees were calculated using data provided by the OECD and Health Insurance Review and Assessment. For indirect comparison by physician income, data obtained from Korea Employment Information Services were used to represent Korean physician income. When compared with other OECD countries, the results suggest that, overall, the Korean fee schedule could be low, based on the fees for C-section, cataract, and appendectomy surgeries. The study results also confirm that Korean physicians' average earnings ranked relatively low among OECD countries. These results are meaningful in that they empirically support the contention that Korean medical fees could be low. In addition, under what is known as national health insurance, in which the medical fee schedule is determined by a single payer, an empirical analysis on medical fee levels, as in this study, has substantial political implications because it may be utilized for medical fee schedule negotiation in the near future. An attempt to directly research fees and the range of services of OECD countries is still needed in order to provide more established data.

Honorários de um cirurgião na Justiça (Vila Boa de Goiás, 1801) / A surgeon's fees in court (Vila Boa de Goiás, 1801)

Estuda-se a ação judicial de cobrança de honorários, proposta em Vila Boa de Goiás (1801), pelo cirurgião-mor André Villela da Cunha Roza, sendo ré a senhora Joanna da Fonseca Coutinha. Enfoca-se a prestação de assistência médica aos escravos, a escassez e o encarecimento deles, a precariedade da formação de físicos e cirurgiões, assim como problemas éticos na cobrança dos honorários em questão.

The article explores the lawsuit brought by Surgeon-Major André Villela da Cunha Roza against Joanna da Fonseca Coutinha in Vila Boa de Goiás in 1801 to recover fees for his services. It examines the health care rendered to slaves, the scarcity and rising prices of these captives, the precarious training received by doctores and surgeons, and the ethical issues entailed in charging the fees in question.