Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

Background: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analyzed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed collection of six standardized indicators: two-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR), and protection against impoverishing and catastrophic expenditure. This study aims to characterize the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods: Using Brazil’s national healthcare database, commonly reported healthcare variables were used to calculate or simulate the six surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of inpatient hospitalization and a gamma distribution of incomes based on GINI and GDP/capita. Findings: In 2014, SAO density is 34·7/100,000 population, surgical volume is 4,433 procedures/100,000 people and POMR is 1·71%. 79·4% of surgical patients are protected against impoverishing expenditure and 84·6% were protected against catastrophic expenditure due to surgery each year. Two-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97·2% of the population has two-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation: Brazil‘s public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation of surgical systems should be encouraged for all nations seeking to better understand their surgical systems. Funding: There was no funding for this study

Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

The present virtual learning object offers a description of the relationships of the basic psychological processes in the organizational context. The basic processes are the basis for developing professional work in the different areas applied.El presente objeto virtual de aprendizaje ofrece una descripción de las relaciones de los procesos psicológicos básicos en el contexto organizacional. Los procesos básicos son la base para desarrollar el quehacer profesional en las diferentes áreas aplicadas.Procesos psicológicos básicos, percepciòn, motivación, emoción y sensación, aprendizaje, atención, memoria1El contenido del recurso, caracteriza y describe los diferentes procesos psicológicos básicos relacionados con la psicología organizacionalEl alcance es para los estudiantes del área profesional III y IV de la electiva organizacional.NingunaComprender, Contextualizar, Recordar, Relacionar, SintetizarPsicologoPregrado.mp4Como apoyo al contenido brindado de manera presencia