Inter-Regional Performance of the Public Health System in a High-Inequality Country (original) (raw)
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Revista de Políticas Públicas
The paper analyses the connection between resources, access, efficiency and effectiveness in 645 municipalities in the São Paulo State, Brazil, between 2009 and 2014. To achieve it, the essay has developed descriptive statistics, correlation analysis and principal component regression analysis. The descriptive statistics have shown high inequality in the health delivered services in resources, access and effectiveness. The correlation analysis has pointed out a possible financial dependence of the municipalities from the transferred funds. Finally, the regression analysis has demonstrated: a non-direct relation between resources and effectiveness in a public health system, a better capacity of the financial and human resources on explaining access and efficiency, and a higher impact of nurses in access and efficiency than physicians in the primary care.
International Journal of Environmental Research and Public Health, 2022
Health equity is cross sectioned by the reproduction of social relations of gender, ethnicity and power. The purpose of this article is to assess how intersectional health equity determines societal health levels, in a local efficiency analysis within Brazil’s Unified Health System (SUS), among Sao Paulo state municipalities. Fixed Panel Effects Model and Data Envelopment Analysis techniques were applied, according to resources, health production and intersectoral dimensions. The effect variables considered were expectation of life at birth and infant mortality rates, in 2000 and 2010, according to local health regions (HR) and regionalized healthcare networks (RRAS). Inequity was assessed both socioeconomically and culturally (income, education, ethnicity and gender). Both methods demonstrated that localities with higher inequities (income and education, gender and ethnicity oriented), associated or not to vulnerability (young and low-income families, in subnormal urban agglomerati...
Relative deficit of health services in Brazilian states and regions
Brazilian Review of Econometrics
The paper analyzes the allocation of health services to Brazilian states and regions. A relative service deficit indicator is constructed to achieve that goal, using equity-based criteria, which means equality of access for equal need. The Data Envelopment Analysis (DEA) is used to estimate the best service availability frontier for equal need. The results show great differences in the availability of health services among Brazilian states and regions. In regional terms, the situation of the South is the best one, whereas the North experiences the worst deficit of health services. These disparities highlight the importance of deficit assessment as an instrument to guide public action, especially in the Brazilian context, where the coverage and availability of health services is a constitutional rule.
Regional health inequalities: changes observed in Brazil from 2000-2016
Brazil. This article examines how socioeconomic transformations, and the complexity of health services, are expressed in the regions established for planning purposes and the inter-governmental management of the Brazilian Unified Health System. An effort was made to identify and explain differences in the compositions of the 438 existing health regions and their spatial distribution by comparing situations observed in 2016 with those in 2000. Factor analysis and grouping techniques were used to construct a typology in the two years of the series, which was based on a diverse set of secondary data sources. It was found that there was an evolution in terms of income levels and service provision within the health regions, with a significant improvement in the socioeconomic conditions of the population. These results suggest that there was a positive impact from the combination of strategies related to social, economic and regional policies for the promotion of development, which generated more widespread well-being within the affected areas. However, limitations remain regarding the policies implemented for the universalization of the health system.
The unified health system of Brazil and the effectiveness of health services
Aim The public health sector in Brazil covers approximately 75% of the population, yet accounts for just 45% of total health expenditure, while the private sector, covering 25%, spends 55% of the resources. The objective of this study, therefore, was to estimate the effectiveness of public and private health activities in Brazil. Subject and methods The study uses data from the time period covering 2008 to 2015, a period when there was considerable economic growth and also an expansion of private health insurance. Using data from 5568 municipalities, the logarithmic linear multivariate regression model was used to estimate the impact of the two sectors on infant, maternal, and preventable diseases mortality rates from 5 to 74 years of age. Results The data showed that in public basic care, the number of public treatments increased 55% in medium complexity cases and 36% in high complexity cases, while private expansion was 19% and 18%, respectively. For hospital admissions, the public sector expanded by 9% in medium complexity cases and 21% in high complexity cases, while private sector admissions decreased by 18% and 43%, respectively. In terms of impact, the number of child deaths fell by approximately 13%. The estimate suggests that, with a 95% confidence interval, an increase of one public establishment per thousand inhabitants reduces, on average, by 189.4% the infant, maternal, and preventable disease mortality rates from ages 5 to 74 years, whereas an additional private establishment per thousand beneficiaries reduces the above mortalities by just 1.9%. Conclusion Underfinancing of public sector health services seems to be the central issue for the development of better public health outcomes in Brazil.
2008
The inadequacy of public services in Brazil today constrains the country's economic growth and social development. The volume of government expenditure is not the principal bottleneck: at over 40 percent of Gross Domestic Product (GDP), Brazil's total public spending is already much higher than that of comparable middle-income countries. The vital question is how to get greater value for public money. As a federal country, improving service delivery in Brazil calls for strengthening the incentives and institutional capacities at the sub-national level, precisely where the country faces its greatest institutional development challenges. A new report examines how particular managerial innovations have been applied in two locations in Brazil to deliver improved public healthcare services. The health sector in Brazil absorbs approximately 4 percent of GDP, and spending levels are likely to rise further given the country's demographic and epidemiological profiles. Improving t...
Bulletin of the World Health Organization, 2004
Objective To examine whether decentralization has improved health system performance in the State of Ceará, northeast Brazil. Methods Ceará is strongly committed to decentralization. A survey across 45 local (município) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture. The indicators for informal management and local political culture were based on prior ethnographic research. Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression. Findings Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators. Conclusion Good management practices in the study led to decentralized local health systems rather than vice versa. Any apparent association between decentralization and performance seems to be an artefact of the informal management, and the wider political culture in which a local health system is embedded strongly influences the performance of local health systems.
Ciência & Saúde Coletiva, 2013
Organizational theory has long emphasized the importance of contingent, environmental influences on organizational performance. Similarly, research has demonstrated the importance of local political culture and informal management on the performance of the local health system, establishing vicious and virtuous circles of influence that contribute to increasing inequalities in performance among decentralized local health systems. A longitudinal ethnography studied the relationship between these elements in the same rural municipality in Northeast Brazil after a four-year interval. The second study found the local health system performance much improved. Two main factors appear to have interacted to bring this about: leadership vision and power to implement of one individual; professionalization of the local health system by hiring a significant number of senior health staff. The origins of these influences combine initiatives at local, state and federal levels.