It's no secret that since 2020, we've been experiencing an important period for telemedicine. We've made progress in months, which we've been trying to achieve in years. Thanks to technology, not only have more than 75,000 lives been saved, but more than 6.5 million unnecessary visits to the emergency room have been avoided. The data comes from a survey we conducted with our associates. And this was only possible because of the authorization for the practice of telemedicine on an emergency basis in 2020.
This seems like the perfect scenario. Except for one detail: Law No. 13,989/2020 will only be in effect until the end of the pandemic. Does this make sense for medicine in Brazil, especially considering that the number of medical appointments via digital means has been increasing exponentially, ensuring and expanding access to healthcare throughout the country?
First, let us remember: “we need to do more with less!” This is a slogan sung throughout the country, but in practice, whether due to the lack of resources and difficulty of access or the immensity of Brazil, for more than 30 years it has stubbornly refused to materialize.
Telehealth and telemedicine are undoubtedly tools that expand access to healthcare and reduce costs. It is through these tools that we can improve the patient experience and reduce waste, since the door to great possibilities is open, of putting the right patient in the right place, at the right time, avoiding delays in diagnosis and procedures, items that are so expensive for systems, thus improving the health of the population.
The major problem of public health financing is not an exclusively Brazilian difficulty; other countries have discussed this challenge extensively. The British health system, for example, which has always been a source of inspiration for our Unified Health System, recognizes that telemedicine, in its entirety, is essential for the sustainability of the health system.
It seems obvious. However, even after so much evidence, very positive data and more than 7.5 million consultations carried out by more than 52.2 thousand doctors via telemedicine in Brazil, 87% of which were “first consultations”, the prohibition of such consultations is one of the central points of discussion for the definitive regulation of telehealth in Brazil, which is being processed in the National Congress. The Federal Council of Medicine (CFM) is requesting that this resource be used only for monitoring chronic diseases and follow-ups and not for first consultations.
Debates like the one we are having here, full of obstacles, end up delaying regulation and putting the country even further behind in terms of technological advances in the health area. In addition, there is no support in the medical literature that justifies the ban.
What makes medicine precarious is not telemedicine. What makes doctors' practice precarious is not the tool used. What makes doctors vulnerable is the existence of an informal market, a regulation that does not guarantee safety and dignity in the practice of medicine. What will make medical practice precarious is a regulation that is so restrictive that it will make practice unfeasible to such an extent that doctors will have to work informally to guarantee their autonomy.
It is a fact that Brazil urgently needs regulation. We need to prevent the country from returning to the 2002 level, the date of the previous rule, because legal uncertainty leads to a lack of development in technology, training of people and structuring of new processes and care models. In other words, when all this is over, we run the risk of setting back the advancement of digital health by almost 20 years. Is this what we want for the health system in Brazil?
Eduardo Cordioli is president of Digital Health Brazil
