Unicamp's health services need to expand to meet demand , says director.

Disproportion between demand and supply of beds impacts the healthcare capacity of the University Hospital de Clínicas

Unicamp's healthcare area is the third largest medical and hospital care center in the interior of São Paulo. Established in the mid-1980s, the complex has established itself over the years as an essential structure for public health in the state, becoming a reference in medical care for a population of over 6 million people.

Covering an area of ​​approximately one hundred municipalities – from the regional health department of Campinas, through Piracicaba and reaching São João da Boa Vista, on the border with the south of Minas Gerais –, the complex is now preparing for an unprecedented phase of transformations, in search of responding to the progressive increase in demand for care.

The center is a reference in high-complexity care, a modality that requires advanced technology, highly specialized professionals and large investments. Among all hospital admissions carried out in the State of São Paulo between 2020 and 2024, the Hospital de Clínicas (HC) of Unicamp recorded the highest proportion in the high-complexity category, even surpassing the Hospital das Clínicas de São Paulo, according to data presented by that institution. The leadership remained in the first quarter of 2025, and the trend is for it to continue.

Units such as HC and Hospital da Mulher Prof. Dr. José Aristodemo Pinotti (Caism) offer specialized care for patients with different types of cancer. Both institutions treat diseases of the blood, ear, nose and throat, as well as issues related to women's and newborn health. HC provides care in 47 medical, clinical and surgical specialties, encompassing 684 subspecialties and covering almost all existing diseases, including rare ones.

Last year, HC performed more than 13.600 elective surgeries and around 3.300 emergency surgeries – most in areas such as ophthalmology, orthopedics, urology, gastrosurgery and vascular surgery –, with more than 12.300 hospitalizations. And it performed 362 transplants – practically one per day –, including 97 cornea transplants, 77 bone marrow transplants and 131 kidney transplants. In addition, the hospital performed almost 2,5 million laboratory tests, around 148 thousand imaging exams and over 55 thousand visits in its Emergency Room.

A year ago, HC acquired the VitalBeam linear accelerator, one of the most modern radiotherapy devices in the world, for the treatment of cancer patients. The equipment is used for cases of prostate, lung, esophageal, stomach, skin, rectal, head and neck cancer, lymphomas, hematological diseases, diseases of the central nervous system and brain, and rare malignant tumors.

The HC also provides free high-cost medicines to hundreds of people, distributing an average of 200 medicines per day. With this type of service alone, around 8.200 patients are treated each month.

The hospital has dozens of cutting-edge equipment, such as autoclaves – used to eliminate bacteria, viruses and fungi from hospital materials – and angiographs, used to visualize and investigate blood vessels and help detect circulatory problems. It also has linear accelerators, used mainly in cancer treatment, as well as ultrasound and digital X-ray equipment, among others.

Today, the institution has one of the best equipped public health structures in the State of São Paulo, which makes it capable of responding, for example, to complex cases such as that of nursing assistant Carla Silvia Almeida.

Approximately eight years ago, Almeida was diagnosed with Behçet's disease (BD), a rare, chronic inflammatory and multisystemic disease, characterized mainly by inflammation of the blood vessels, affecting several organs and systems of the body, such as skin, eyes, joints and nerves.

During the acute phase of the crisis, the nursing assistant spent six months hospitalized and lost a lot of weight, weighing 38 kg – half her normal weight – and lost 70% of her vision in her right eye. The patient also developed dermatological, ophthalmological and gastrointestinal problems, many of which were due to the unwanted side effects of the medication she was prescribed. While being treated at the Unicamp HC, Almeida began receiving special and expensive medication, taking a R$5 injection every two weeks. This phase of treatment ended in April and, from now on, she must return to the hospital every four months to have her condition monitored. “I am doing very well. In fact, I haven’t felt this well in many years,” she said in the last week of May, as she was leaving a hospital appointment. “I am biased, but I can only speak highly of the HC, which has very capable professionals who inspire confidence in us.”

The knot

“The problem is not the structure already in place,” says Luiz Carlos Zeferino, a professor at the Department of Obstetrics and Gynecology at the School of Medical Sciences (FCM), who currently heads the Executive Board of the Health Area (Deas) at Unicamp. “Our biggest problem is the huge disproportion between our healthcare capacity and the area of ​​reference in which we operate,” he explains.

Zeferino notes, for example, that the population served by HC and Caism is much larger than the current supply of beds. The director compares the disproportion in the numbers at HC Unicamp with two other important service centers of the Unified Health System (SUS) in the interior of São Paulo: the Hospital das Clínicas of the Ribeirão Preto School of Medicine (of the University of São Paulo – USP) and the Base Hospital of the São José do Rio Preto School of Medicine.

While the Unicamp system has 560 beds for a population dependent on the SUS that reaches 4,2 million people – a ratio of 7.500 patients per bed –, the HC of the Ribeirão Medical School has 800 beds for a population dependent on the SUS of 2,6 million people, a ratio of 3.300 patients per bed. The Hospital de Base de Rio Preto has 900 beds for a demand of 2,4 million people – a ratio of 2.700 patients per bed.

As if this discrepancy were not enough, the regions of Ribeirão Preto and Rio Preto have, according to Zeferino, another advantage. “Both are 100 km away from the Barretos Cancer Hospital, which absorbs a large part of the demand generated by oncology,” he explains. “In addition to being larger than us, they also have this relief. In our region, apart from HC da Unicamp, the only service that specifically treats cancer is Boldrini [Centro Boldrini]. But it only treats children. There is no care for adults. So, what happens? Which hospital in the region treats the most of these types of patients? Ours.”

Zeferino draws attention to another complicating factor, resulting from the rule that ensures that patients in the most serious condition take precedence over others. “There is a significant bottleneck, and patients in the most serious condition generally spend more time in hospital. This means that the average cost per patient here at Unicamp tends to be higher.” This factor has a strong impact on costs and generates another undesirable outcome: since the HC is unable to handle all the high-complexity demand, many patients end up being referred to medium-complexity hospitals in the region.

“You go to Ouro Verde [Campinas Municipal Hospital], which is supposed to be a medium-complexity hospital, and they are operating on prostate cancer there. The Sumaré Hospital receives serious cases. The same happens with the Mário Covas Hospital in Hortolândia,” he says.

According to the director, the problem is not management. The fundamental issue is the difference between the physical and operational structure of the system and the demand for care. “And this difference is huge.”

Córdoba

Last year, healthcare costs reached approximately R$900 million. Of this amount, 70% was covered by Unicamp. In addition to the University providing its own funds to pay the largest portion of the system's costs, there is another aggravating factor. The funds provided by the Ministry of Health do not cover the remaining 30%.

Between 2021 and 2024, Unicamp had to make successive supplements that, together, totaled R$134 million – the equivalent of R$33,4 million per year. It is expected that the cost of the University's healthcare area will exceed R$1 billion in 2025.

The need to build another large facility is evident in the numbers. Zeferino says he conducted a survey on the infrastructure gap and concluded that the Unicamp system would need at least a thousand more beds. According to the director, there is no doubt that the city and the region need a new hospital.

“Unicamp has worked and is working to make this happen. It could be at Unicamp or outside of it, but it needs to happen,” he says. “And it’s not Unicamp that needs this, it’s the SUS,” he warns. “I say that the problem is with the SUS because these problems we’re talking about are problems with the public health system, which end up affecting the functioning of Unicamp.”

Last year, when preparing the management closing report, teams from the Center for Public Policy Studies (Nepp) and Deas itself presented the proposal to create a regional hospital.

According to the plan, the unit should be part of the Regional Health Care Network 15 (RRAS-15) – which includes the health regions (RS) of the Metropolitan Region of Campinas (RMC), Circuito das Águas, Baixa Mogiana, Mantiqueira and São José do Rio Pardo.

According to this model, Unicamp proposes to transfer less complex actions to this regional hospital and proportionally expand its hospital capacity in order to absorb the pent-up oncological demand in RS-15, both in outpatient care and inpatient treatment.

The study also points out that, in this RS, there is a large number of hospital beds with low production capacity, with low occupancy and high idleness, these beds being installed in small hospitals (less than one hundred beds), operating in smaller municipalities. Due to the technological inadequacy and lack of training of health teams, this situation contributes to increasing the overload of regional reference hospitals.

“Unicamp is in a moment where it is truly discussing its importance in healthcare and receiving much more external support – from the state and federal governments,” says the university’s rector, Professor Paulo Cesar Montagner. According to Montagner, Unicamp’s healthcare area has good infrastructure and a quality technical staff, but it suffers from excessive demand. “Therefore, it is necessary for Campinas and the entire region to receive more hospitals and more beds so that, together with us, they can better serve our population.”

Governor

In the first week of June, the governor of the state of São Paulo, Tarcísio de Freitas, acknowledged the need to build a new hospital in Campinas. The politician stated that he was negotiating the concession of a plot of land with the city government of Campinas and that the bidding process for the project should begin in the second half of this year. The future unit, with a capacity for 400 beds, would have a regional character.