On the last 28th of July, the Brazilian College of Radiology and Diagnostic Imaging (CBR) was again present at a discussion held between entities mobilized against tax increases, held at the headquarters of the Federation of Hospitals, Clinics and Laboratories of the State of São Paulo Paulo (FEHOESP), in the capital of São Paulo.
The question is related to the perspectives of proceeding with the tax reform. Due to the low probabilities of a broader reform, the government has signaled the possibility of proceeding with the tax changes gradually, with the first change focused on the collection model of the Social Integration Program (PIS) and the Contribution for Financing of Social Security (Cofins). The concern is that the proposed changes, such as the migration from the current cumulative model to the non-cumulative one, will put even greater pressure on the reduced operating margins of the service sector, especially on healthcare companies, which have high labor costs specialized.
Under the cumulative regime, although the calculation base does not benefit from deductions for expenses and other charges, the contribution rates are lower, at 0.65% for PIS and 3% for Cofins. In the non-cumulative regime, widely applied in the industrial sector, the contribution rates are 1.65% and 7.6% for PIS and Cofins respectively. The non-cumulative regime brings advantages in sectors where the production chain is long or complex, such as industry, due to the incidence of deductions. However, in the health sector, a large part of the costs is linked to the high use of human resources, whose costs cannot be deducted from the calculation base.
Certainly, it is not expected that the proposed reform will be restricted only to changes in the PIS/Cofins payment system. However, the tax burden can be disproportionately high according to the rate to be defined, and in the case of simplification between the cumulative and non-cumulative regimes, with greater penalization of the service sector, precisely the one with great potential for recovery in the supply of services. jobs.
Experts believe that this potential tax increase will put even more pressure on medical-hospital inflation, with narrowing margins and transferring costs to the final consumer. In fact, in this situation, the entire chain will be affected, with the migration of lives to more accessible health plans or, worse than that, with an overload of the public health care network. In this case, there is a risk that the final bill for the government will become even greater, by discouraging the performance of private providers in supplementary health, making the already precarious public health network unfeasible.
On the one hand, the new definitive rules have not yet been released, which makes broader discussions impossible. On the other hand, any increase in the tax burden on health could pose a risk to the tenuous financial balance of the sector, causing difficulties especially for smaller companies.
Faced with this scenario, several institutions are mobilizing to broaden the analysis of the issue and promote a more in-depth discussion. Certainly, the reform of the Brazilian tax system should be a priority, but without harming sectors with broad employability such as health, already vulnerable due to the flattening of operating margins that occurred in recent years.