O Estado de Saúde Individual e as Diferenças Salariais no Brasil em 2003 e 2008

O artigo investiga as diferenças salariais segundo o estado de saúde individual no Brasil. Para identificar os fatores que mais contribuem para o diferencial salarial o método empregado consiste na decomposição de Blinder-Oaxaca, considerando o procedimento de Heckman. A condição de saúde é mensurada pela autoavaliação dos indivíduos e pela prevalência de doenças crônicas. Os resultados apontam que indivíduos saudáveis são mais bem remunerados, sendo os salários dos indivíduos que não reportaram uma boa saúde em torno de 34% a menos em relação aos que reportaram uma boa saúde, e para indivíduos que indicaram prevalência de doenças crônicas de 38% a menos em relação a aqueles que não indicaram. A escolaridade destaca-se dentre as características ao explicar parte dessa diferença salarial, contribuindo principalmente para o diferencial do grupo que autoavaliou seu estado de saúde. Contudo, fatores não explicados, que correspondem a características não observáveis e a discriminação, são os que mais contribuem para a diferença de salários.

Primary care physicians and infant mortality : Evidence from Brazil

Primary health care has been recognized as a critical strategy for improving population health in developing countries. This paper investigates the effect of primary care physicians on the infant mortality rate in Brazil using a dynamic panel data approach. This method accounts for the endogeneity problem and the persistence of infant mortality over time. The empirical analysis uses an eight-year panel of municipalities between 2005 and 2012. The results indicate that primary care physician supply contributed to the decline of infant mortality in Brazil. An increase of one primary care physician per 10,000 population was associated with 7.08 fewer infant deaths per 10,000 live births. This suggests that, in addition to other determinants, primary care physicians can play an important role in accounting for the reduction of infant mortality rates

The disruption of elective procedures due to COVID‑19 in Brazil in 2020

Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unifed Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the efect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This efort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require eforts by health agencies to meet this demand

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018.

BACKGROUND: Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities. METHODS: We conducted a fixed effect panel data analysis over the period of 2009-2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs. RESULTS: The results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0-64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (-0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected. CONCLUSION: We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs

Choroba kosztów opieki zdrowotnej i braku wzrostu

This study examines whether health care is affected by Baumol’s cost disease in a scenario of no growth. Baumol's model implies that stagnant sectors are driven by wage increases in excess of productivity growth. But in a no growth economy the income is constant. It is investigated in two institutional proposals, selective reduction of productivity and reduction of working hours. In both scenarios the cost disease does not affects the health care. However, in the second scenario an important result is found. In this sector, with slow productivity growth, will be necessary a greater number of workers. The relative cost of health care will increase over the years. Therefore, although the cost disease does not affect the health sector in a no growth economy, the relative cost of health should continue to rise.W niniejszym artykule zbadano, czy opieka zdrowotna znajduje się pod wpływem choroby kosztów Baumola w scenariuszu zerowego wzrostu. Według modelu Baumola na sektory znajdujące się w stagnacji oddziałuje wzrost płac wywołany wzrostem produktywności. Jednak w gospodarce o wzroście zerowym dochód jest stały. Przebadano to w dwóch przypadkach instytucjonalnych, selektywnej redukcji produktywności oraz redukcji godzin pracy. W obu przypadkach choroba kosztów nie wpłynęła na opiekę zdrowotną. Jednak drugi scenariusz dostarczył bardzo istotnych wyników. W analizowanym sektorze, przy powolnym wzroście produktywności, niezbędna będzie większa liczba pracowników. W przeciągu następnych lat relatywny koszt opieki zdrowotnej wzrośnie. Z tego względu, mimo że choroba kosztów nie dotyczy sektora zdrowotnego, relatywny koszt opieki zdrowotnej będzie nadal rósł

Choroba kosztów opieki zdrowotnej i braku wzrostu

This study examines whether health care is affected by Baumol’s cost disease in a scenario of no growth. Baumol's model implies that stagnant sectors are driven by wage increases in excess of productivity growth. But in a no growth economy the income is constant. It is investigated in two institutional proposals, selective reduction of productivity and reduction of working hours. In both scenarios the cost disease does not affects the health care. However, in the second scenario an important result is found. In this sector, with slow productivity growth, will be necessary a greater number of workers. The relative cost of health care will increase over the years. Therefore, although the cost disease does not affect the health sector in a no growth economy, the relative cost of health should continue to rise.W niniejszym artykule zbadano, czy opieka zdrowotna znajduje się pod wpływem choroby kosztów Baumola w scenariuszu zerowego wzrostu. Według modelu Baumola na sektory znajdujące się w stagnacji oddziałuje wzrost płac wywołany wzrostem produktywności. Jednak w gospodarce o wzroście zerowym dochód jest stały. Przebadano to w dwóch przypadkach instytucjonalnych, selektywnej redukcji produktywności oraz redukcji godzin pracy. W obu przypadkach choroba kosztów nie wpłynęła na opiekę zdrowotną. Jednak drugi scenariusz dostarczył bardzo istotnych wyników. W analizowanym sektorze, przy powolnym wzroście produktywności, niezbędna będzie większa liczba pracowników. W przeciągu następnych lat relatywny koszt opieki zdrowotnej wzrośnie. Z tego względu, mimo że choroba kosztów nie dotyczy sektora zdrowotnego, relatywny koszt opieki zdrowotnej będzie nadal rósł

Choroba kosztów opieki zdrowotnej i braku wzrostu

This study examines whether health care is affected by Baumol’s cost disease in a scenario of no growth. Baumol's model implies that stagnant sectors are driven by wage increases in excess of productivity growth. But in a no growth economy the income is constant. It is investigated in two institutional proposals, selective reduction of productivity and reduction of working hours. In both scenarios the cost disease does not affects the health care. However, in the second scenario an important result is found. In this sector, with slow productivity growth, will be necessary a greater number of workers. The relative cost of health care will increase over the years. Therefore, although the cost disease does not affect the health sector in a no growth economy, the relative cost of health should continue to rise.W niniejszym artykule zbadano, czy opieka zdrowotna znajduje się pod wpływem choroby kosztów Baumola w scenariuszu zerowego wzrostu. Według modelu Baumola na sektory znajdujące się w stagnacji oddziałuje wzrost płac wywołany wzrostem produktywności. Jednak w gospodarce o wzroście zerowym dochód jest stały. Przebadano to w dwóch przypadkach instytucjonalnych, selektywnej redukcji produktywności oraz redukcji godzin pracy. W obu przypadkach choroba kosztów nie wpłynęła na opiekę zdrowotną. Jednak drugi scenariusz dostarczył bardzo istotnych wyników. W analizowanym sektorze, przy powolnym wzroście produktywności, niezbędna będzie większa liczba pracowników. W przeciągu następnych lat relatywny koszt opieki zdrowotnej wzrośnie. Z tego względu, mimo że choroba kosztów nie dotyczy sektora zdrowotnego, relatywny koszt opieki zdrowotnej będzie nadal rósł

The health influence on returns to education in Brazil: A nonlinear approach

This paper investigates the returns to education in terms of individuals’ health in Brazil. We use the Heckman procedure (1979) and a nonlinear model that allows the consideration of the existence of increasing returns. The study employs microdata from National Survey by Household Sample for 2003 and 2008. The health status is measured by self-assessment of individuals. We determine that the rate of returns decreases until the fourth and fifth years of schooling, that is, until the completion of primary education when increasing returns start. The evidence also indicates that the rate of return to education is lower for individuals in poor health; for people with 15 or more years of schooling, the rate of return is 10–14.5% lower for those who are unhealthy

Association of the new zero‑tolerance drinking and driving law with hospitalization rate due to road trafc injuries in Brazil

We investigated the association of the new zero-tolerance drinking and driving law (Law 12,760, Dec. 2012) with hospital admissions due to road trafc injuries in Brazil by using interrupted time series from 2008 to 2019. We used linear regression designed to adjust for autocorrelation and Cumby–Huizinga test for residual autocorrelation. Newey–West standard errors was used to handle heteroscedasticity. We used ICD-10 codes for land transport accidents (V01–V89). The hospitalization rate was calculated per 100,000 inhabitants. The sources were the Hospital Information System and the Brazilian Institute for Geography and Statistics. Pre- and postintervention consist of 59 and 85 months, respectively. For Brazil, the hospitalization rate was associated with a reduction of 0.34 (p = 0.097; 95% CI − 0.74 to 0.06) in the frst month of the intervention (Dec. 2012), followed by a signifcant change in the hospitalization trend. Compared to the period prior to the intervention, the monthly trend was associated with a reduction of 0.05 (p < 0.01; 95% CI − 0.06 to − 0.04) in the post period. These results stand in agreement with subgroup analyses for the Brazilian regions, although North and Northeast regions did not immediately reduce hospitalization rates (level change). Our results suggested that 440,599 hospitalizations for land transport accidents would be averted by the new zero-tolerance drinking and driving law from Dec. 2012 to Dec. 2019 in Brazil. Even using a quasiexperimental approach, our fndings must be interpreted with caution due to observational design and registration faws surrounding our data.Faculdade UnB Ceilândia (FCE)Curso de Saúde Coletiva (FCE-SC