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http://www.bloomberg.com/apps/news?pid=20601086&sid=aZkXTF.sbA50&refer=latin_america
Brazil's Ban on Doctor-Lender Ties May Nip Plastic Surgery Boom
USA
By Adriana Brasileiro
April 17 (Bloomberg) -- Ana Maria Silveira planned to follow a
customary route for Brazilians seeking plastic surgery when she
decided to get breast implants. First the finance company, then the
doctor.
The 31-year-old Rio de Janeiro manicurist never made it to the
surgeon.
In a move that threatens Brazil's status as a world center for
cosmetic surgery, the Federal Medical Council last month banned ties
between doctors and lending firms that help people pay for the
operations. The council cited interest rates as high as 55 percent
that almost double the cost of procedures.
The finance companies, which call themselves "health- services
brokers,'' operate "just like loan sharks do in the streets of poor
communities,'' said Roberto D'Avila, president of the council. "It's
against medical ethics and exposes people to serious risks.''
The group's ruling has the effect of law. Doctors who continue to do
business with the financial agencies will lose their medical licenses,
D'Avila said. The council isn't aware of injuries caused by the
arrangements and acted "to prevent any tragedies,'' he said.
Second to U.S.
Plastic surgery, a privilege of wealthy Brazilians until the late
1980s, has grown to a $4 billion business from about $1.5 billion in
2003, according to Brazil's Plastic Surgery Society in Sao Paulo.
Brazil ranks second only to the U.S., where $13 billion was spent on
cosmetic procedures last year, according to the American Society for
Aesthetic Plastic Surgery in Los Alamitos, California.
Brazil, with a population of 190 million, has almost 4,100 registered
plastic surgeons, compared with 5,000 in the U.S., which has a
population of 301 million.
The growth has been fueled by increased demand for plastic surgery
from lower-income Brazilians and a rise in loan companies affiliated
with doctors who provide the services. There are about 100 such firms
now, about double the number in 2003, according to Arnaldo Korn,
director of the National Center of Plastic Surgery, a Sao Paulo
company that finances surgeries.
The lenders, also called agencies, provide installment payment plans,
set up consultations, blood tests and physical examinations, and
schedule the operations.
Counting on Loan
Silveira, the Rio manicurist, was counting on a loan from one of those
lenders, Rio-based Esteticplan. Now she says she has to abandon her
plan to add a cup size to her breasts.
"I can't pay for it in cash,'' Silveira said. "I need long-term
financing for this surgery, and the agencies are the easiest way.''
Officials of Esteticplan didn't respond to phone calls seeking
comment.
Plano Top, a Sao Paulo agency, allowed patients to pay for breast
implants in 36 monthly installments of 217 reais ($125), according to
prices posted on the company's Web site that were removed after the
ruling. The total price tag of 7,812 reais was almost twice the amount
charged to people who paid up front. Plano Top representatives didn't
return phone calls seeking comment.
Many patients like Silveira, who planned to pay for the surgery in 24
installments, were required to sign the financing contract before ever
meeting with a doctor, according to the Federal Medical Council, the
Plastic Surgery Society and the Consumer Protection Agency, known as
Procon.
Doctor and Patient
The relation****p between patient and doctor, "which starts with a
simple consultation, is the basis for any treatment,'' Ivo Pitanguy,
81, the plastic surgeon who invented the so-called Brazilian
butt-lift, said in an e-mail. "It's only through personal contact with
the doctor that the best decision can be made.''
The finance companies may appeal the decision, said Korn of the
National Center of Plastic Surgery. To ban doctors from working with
the agencies means cosmetic surgery will be out of reach for many
Brazilians, he said.
The medical council is "going against the global trend to make medical
treatments more democratic,'' Korn said in an interview. "It's fair to
give not-so-wealthy people access to services that for a long time
were available just to the rich.''
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