Supplemental care from a bioethical perspective.

OBJECTIVE: To describe and analyze, from the perspective of Intervention Bioethics, the legal, institutional and ethical contexts, the conflicts and regulations of supplemental health care in Brazil, since the approval of the regulatory law in 1998 until 2010. METHODS: Qualitative research, using Intervention Bioethics as the theoretical reference. Bibliographical and documental study of the legislation, regulations and assistential framework, as well as interviews with members of the Supplemental Health Board. RESULTS: There was improvement in the records and rules of action in private health companies, as well as flow of information, contractual and financial guarantees provided to consumers. Conflicts persist regarding access to services and procedures, price increases, policies on autonomy and medical fees. There is a dispute with the public sector regarding the network of health services, with rising costs and no improvement in quality of care. DISCUSSION: Private participation in health demands comparative assessments and improvement of public-private care regulation, as well as promoting greater balance in the funding and reevaluation of the health care model. CONCLUSION: It is necessary to review the regulatory framework considering the supplementary, complementary or duplicate characteristic of assistance, the social actors involved, bioethical and political issues regarding associations between Supplemental Health Care and the National Health System (SUS).

Rastreamento e diagnóstico de câncer de próstata / Screening and diagnosis of prostate cancer

Não existem até o momento provas contundentes que a população coberta pelo plano de saúde UNIMED-POA deva ser submetida ao rastreamento sistemático do câncer de próstata com o intuito de reduzir a mortalidade decorrente deste tipo de câncer, uma vez que não existem estudos desenhados no Estado do Rio Grande do Sul que contemplem este aspecto. Recentemente, dois grandes estudos randomizados que visavam a esclarecer se o rastreamento populacional poderia reduzir a mortalidade por câncer de próstata concluíram: em estudo realizado nos Estados Unidos (prostate, lung, colorectal and ovary trial), não houve diferença na mortalidade da população rastreada ou não; no estudo europeu (European randomized of screening for prostate cancer), houve uma redução de 20 por cento da mortalidade da população rastreada em relação à não rastreada. Cabe ressaltar que ambos os estudos apresentaram, entre outros problemas, viés de seleção dos pacientes, onde mais de 50 por cento do grupo teoricamente não rastreado efetivamente realizou exames antes ou durante o estudo. Sendo assim, permanece recomendada realização de rastreamento nas diretrizes da Associação Americana de Urologia, Associação Europeia de Urologia e Sociedade Brasileira de Urologia.

So far, there is no compelling evidence that the local population covered by the health plan UNIMED-POA should be submitted to systematic screening for prostate cancer in order to reduce mortality resulting from this type of cancer, as no studies in Rio Grande do Sul have been performed to address this particular issue. In other countries, two large randomized studies aimed at clarifying whether such screening could reduce mortality from prostate cancer were conducted recently: the prostate, lung, colorectal and ovary trial in the United States, and the European randomized screening for prostate cancer. In the former, there was no difference in mortality between screened and non-screened groups; in the latter there was a 20 percent reduction in mortality in the screened as compared to the non-screened group. It should be highlighted that both studies had many design problems including biased selection of patients, as more than 50 percent of the supposedly non-screened group was in fact submitted to medical tests either before or during the trial. Therefore, screening still should be performed according to the guidelines of the American Association of Urology, European Association of Urology and the Brazilian Society of Urology.