Social inequality in the access to healthcare services in Brazil

healthcare services; Brazil; social inequality

A IMPORTÂNCIA DA SAÚDE COMO UM DOS DETERMINANTES DA DISTRIBUIÇÃO DE RENDIMENTOS E POBREZA NO BRASIL

One of the main social economic problems observed in the majority of countries, in particularly, in the less developed countries, is the high level of income inequality and poverty. In Brazil, these facts are especially important because our country presents one of the worst income distributions in the world that results in a gini coefficient around 0,607. The aim of this paper is to study the relationship between health status, income distribution and the level of poverty in Brazil. Specifically, we are interested in evaluate how health status impacts income distribution and the level of poverty. The methodology used in this work is an adaptation of the micro simulation method proposed by Bourguignon, Ferreira e Lusting (2001). To analyse health effects over income distribution and the level of poverty we used two inequality indexes (Gini coefficient and T-Theil index) and three poverty measures - poor proportion, income gap and quadratic income gap. Our database is PNAD 98 (National Household Survey) that presents a special survey about health status and other related subjects. Our main findings points that health status affects both income distribution and level of poverty.

Desigualdades sociais em saúde: evidências empíricas sobre o caso brasileiro

The aim of this paper is to measure the socioeconomic health inequality in Brazil considering the differences among the federal states. We estimate the health concentration index. This work has two main contributions: first, it considers the differences in the health level of population among the federal states and second, it measures the socioeconomic health inequality considering all socioeconomic groups. The socioeconomic variables used are years of formal schooling and familiar income per capita. Even though, the majority of papers in the literature estimate health inequality using mortality as health indicator, in this paper we use morbidity measures. Morbidity measures are advantageous because they capture differences in the life quality of individuals in spite of only considering the cause of death. The data base used is PNAD (Pesquisa Nacional de Amostra Domiciliar), a National Household Survey accomplished by the Brazilian Institute of Geography and Statistics (IBGE). The main findings of this work is to perceive the existence of social health inequality in Brazil. Almost all health concentration indexes estimated showed a health inequality favoring the higher income groups. This result was robust for almost all health indicators except when the criteria used was the proportion of individuals in the whole population that presented chronic disease. This result was verified in all regions except the Northeastern region when we used familiar income per capita to classify social economic groups.healthcare services; Brazil; social inequality

Impact Assessment of the Program for Strenghthening and Improving the Quality of Hospitals SUS – State of Minas Gerais/Brazil (Pro-Hosp)

Este estudo avaliou o impacto do Programa de Fortalecimento e Melhoria da Qualidade dos Hospitais do SUS-MG (Pro-Hosp). Para tanto, foi empregado o método diferenças-em-diferenças, que permite avaliar o impacto de políticas públicas quando o indicador avaliado é observado em mais de um período no tempo. Foram selecionados quatro indicadores de desempenho hospitalar: a proporção média de cesárea, a taxa média de ocupação, a taxa média de mortalidade e o tempo médio de permanência. Constatou-se que o Pro-Hosp teve impacto na proporção média de cesáreas no sentido esperado, ou seja, de reduzi-lasEste estudio evaluó el impacto del Programa de Fortalecimiento y Mejora de la Calidad de los Hospitales del SUS-MG (Pro-Hosp). Por lo tanto, se empleó el método de diferencia en diferencia, lo que nos permite evaluar el impacto de las políticas públicas cuando el indicador evaluado se observa em más de um período de tiempo. Se seleccionaron cuatro indicadores de desempeño de los hospitales: la proporción media de cesáreas, la tasa media de ocupación, la tasa media de mortalidad y estancia media. Se encontró que el Pro- Hosp impactó la proporción media de cesáreas en la dirección esperada, es decir, para reducirlasThis study evaluated the impact of the Program for Strengthening and Improving the Quality of Hospitals SUS-MG (Pro-Hosp). Therefore, the method employed was difference-in-difference, which allows us to evaluate the impact of public policy when the indicator assessed is observed in more than one period in time. We selected four indicators of hospital performance: the average proportion of cesarean section, the average occupancy rate, the average mortality rate and average lengh of stay. It was found that the Pro-Hosp impacted the average proportion of cesarean sections in the expected direction, i.e. to reduce themRevista do Serviço Público - RSP, v. 65, n. 1, p. 65-85Políticas Públicas e SociaisSaúdeISSN eletrônico: 2357-8017ISSN impresso: 0034-924

Determinantes dos Gastos das Famílias com Saúde no Brasil

This article aims to analyze the structure and the composition of the private spending on health care among Brazilian families. This is an important issue given not only the importance of the private component on the total expenditure on health in Brazil but also the effects of this kind of expense over the individual health status. As a result public policy makers seem to be more concerned about the population health status and the provision of health care services. The results suggest the presence of social inequalities on the use of primary and secondary heath care, since the probability to spend and the value spent were sensitive to the income and educational level of the head of the household. Regarding hospital services, the spending was less sensitive to the social-economic measures.Gastos com Saúde, Gastos per capita, Setor Privado de Saúde

What matters most?: evidence-based findings of health dimensions affecting the societal preferences for EQ-5D health states

This study analyzes how different health dimensions defined by the EQ-5D-3L instrument affect average individual preferences for health states. This analysis is an important benchmark for the incorporation of health technologies as it takes into consideration Brazilian population preferences in health resource allocation decisions. The EQ-5D instrument defines health in terms of five dimensions (mobility, daily activities, self-care activities, pain/discomfort, and anxiety/depression) each divided into three levels of severity. Data came from a valuation study with 3,362 literate individuals aged between 18 and 64 living in urban areas of Minas Gerais State, Brazil. The main results reveal that health utility decreases as the level of severity increases. With regard to health issues, mobility stands out as the most important EQ-5D dimension. Independently of severity levels of the other EQ-5D-3L dimensions, the highest decrements in utilities are associated with severe mobility problems