Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010–2019
Abstract
:1. Introduction
2. Materials and Methods
Generalized Linear Model Development
3. Results
Coefficients | Estimated | Exp Estimated | Standard Error | Z Calculated | p-Value |
---|---|---|---|---|---|
Intercept Y | 6595 | 731,429 | 0.053 | 124,458 | 0 |
2010 | - | - | - | - | - |
2011 | 0.003 | 1.003 | 0.002 | 1.777 | 0.076 |
2012 | 0.077 | 1.080 | 0.002 | 47.437 | 0 |
2013 | 0.128 | 1.137 | 0.002 | 80.293 | 0 |
2014 | 0.201 | 1.223 | 0.002 | 127.03 | 0 |
2015 | 0.145 | 1.156 | 0.002 | 91.709 | 0 |
2016 | 0.256 | 1.292 | 0.002 | 162.202 | 0 |
2017 | 0.238 | 1.269 | 0.002 | 152.55 | 0 |
2018 | 0.274 | 1.315 | 0.002 | 176.33 | 0 |
2019 | 0.228 | 1.256 | 0.002 | 148.869 | 0 |
PE | - | - | - | - | - |
RR | −0.36 | 0.698 | 0.011 | −32.082 | 0 |
RO | −0.314 | 0.731 | 0.006 | −52.241 | 0 |
AC | −0.199 | 0.82 | 0.01 | −20.552 | 0 |
RJ | −0.184 | 0.832 | 0.002 | −86.042 | 0 |
TO | −0.149 | 0.862 | 0.005 | −31.125 | 0 |
DF | −0.092 | 0.912 | 0.003 | −29.987 | 0 |
MT | −0.088 | 0.916 | 0.004 | −20.944 | 0 |
AP | −0.059 | 0.943 | 0.013 | −4.698 | 0 |
PB | −0.049 | 0.952 | 0.003 | −15.259 | 0 |
AM | −0.043 | 0.958 | 0.004 | −10.594 | 0 |
MS | −0.04 | 0.961 | 0.003 | −12.628 | 0 |
SP | −0.035 | 0.966 | 0.002 | −21.614 | 0 |
PI | −0.032 | 0.969 | 0.004 | −9.132 | 0 |
RS | −0.004 | 0.996 | 0.002 | −2.137 | 0.033 |
PA | 0.009 | 1.009 | 0.004 | 2.47 | 0.014 |
ES | 0.059 | 1.061 | 0.003 | 22.281 | 0 |
SC | 0.059 | 1.061 | 0.002 | 26.733 | 0 |
AL | 0.061 | 1.063 | 0.004 | 16.659 | 0 |
MA | 0.063 | 1.065 | 0.003 | 18.346 | 0 |
MG | 0.067 | 1.069 | 0.002 | 36.178 | 0 |
PR | 0.084 | 1.088 | 0.002 | 45.283 | 0 |
RN | 0.103 | 1.108 | 0.003 | 34.97 | 0 |
BA | 0.117 | 1.124 | 0.002 | 55.224 | 0 |
SE | 0.159 | 1.172 | 0.006 | 27.948 | 0 |
CE | 0.169 | 1.184 | 0.002 | 70.498 | 0 |
GO | 0.213 | 1.237 | 0.003 | 78.702 | 0 |
Life | - | - | - | - | - |
Death | 0.243 | 1.275 | 0.002 | 126.875 | 0 |
Female | - | - | - | - | - |
Male | 0.025 | 1.025 | 0.001 | 37.389 | 0 |
White | - | - | - | - | - |
Yellow | −0.033 | 0.968 | 0.003 | −9.555 | 0 |
Indigenous | −0.016 | 0.984 | 0.018 | −0.936 | 0.349 |
ND | −0.079 | 0.924 | 0.001 | −76.361 | 0 |
Black | 0.031 | 1.031 | 0.002 | 17.639 | 0 |
Brown | 0.031 | 1.031 | 0.001 | 32.281 | 0 |
Age | −0.001 | 0.999 | 0 | −37.253 | 0 |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Brasil. Casa Civil. Constituição da República Federativa do Brasil de 1988. Available online: https://www.planalto.gov.br/ccivil_03/Constituicao/Constituicao.htm (accessed on 9 July 2022).
- Brasil. Casa Civil. Lei n° 8.080/1990, de 19 de Setembro de 1990. Dispõe Sobre as Condições para a Promoção, Proteção e Recuperação da Saúde, a Organização e o Funcionamento dos Serviços Correspondentes e dá Outras Providências. Available online: https://www.planalto.gov.br/ccivil_03/LEIS/L8080.htm (accessed on 9 July 2022).
- Brasil. Ministério da Saúde. Ministério da Saúde. O SUS de A a Z: Garantindo Saúde nos Municípios, 3rd ed.; Série F. Comunicação e Educação em Saúde; Editora do Ministério da Saúde: Brasília, Brasil, 2009.
- Arreguy, E.E.M.; Schramm, F.R. Bioética do Sistema Único de Saúde-SUS: Uma análise pela bioética de proteção. Rev. Bras. Cancerol. 2005, 51, 117–122. [Google Scholar] [CrossRef]
- Castro, A.; Sáenz, R.; Avellaneda, X.; Cáceres, C.; Galvão, L.; Mas, P.; Ritterbusch, A.E.; Fuentes, M.U. The Health Equity Network of the Americas: Inclusion, commitment, and action. Rev. Panam Salud Publica 2021, 45, e79. [Google Scholar] [PubMed]
- Kavanagh, M.M.; Norato, L.F.; Friedman, E.A.; Armbrister, A. Planing for health equity in the Americas: An analysis of national health plans. Rev. Panam Salud Publica 2021, 45, e29. [Google Scholar] [CrossRef] [PubMed]
- Hsiao, W.C. Why is a sistematic view of health financing necessary? Health Aff. 2007, 26, 950–961. [Google Scholar] [CrossRef] [PubMed]
- Karanikolos, M.; Heino, P.; McKee, M.; Stucker, D.; Legido-Quigley, H. Effects of the global financial crisis on health in high-income OECD countries: A narrative review. Int. J. Health Serv. 2016, 46, 208–240. [Google Scholar] [CrossRef] [PubMed]
- Instituto Brasileiro de Geografia e Estatística—IBGE. Indicadores; IBGE: Rio de Janeiro, Brasil, 2022. Available online: https://ibge.gov.br/pt/inicio (accessed on 12 July 2022).
- Piola, S.F.; Servo, L.M.; Sá, E.B.; Paiva, A.B. Financiamento do Sistema Único de Saúde—Trajetória recente e cenários para o futuro. Análise Econômica 2012, 30. [Google Scholar] [CrossRef]
- Begley, C.E.; Aday, L.A.; Lairson, D.R.; Slater, C.H. Expanding the Scope of Health Reform: Application in the United States. Soc. Sci. Med. 2002, 55, 1213–1229. [Google Scholar] [CrossRef] [PubMed]
- Brasil. Ministério da Saúde. Morbidade Hospitalar do SUS. 2022. Available online: http://tabnet.datasus.gov.br/cgi/menu_tabnet_php.htm# (accessed on 12 July 2022).
- Instituto Brasileiro de Geografia e Estatística—IBGE. Códigos dos Municípios; IBGE: Rio de Janeiro, Brasil, 2021.
- Nelder, J.A.; Wedderburn, R.W.M. Generalized linear models. J. R. Stat. Soc. Ser. A (Gen.) 1972, 135, 370–384. [Google Scholar]
- Mccullagh, P.; Nelder, J.A. Generalized Linear Models; Routledge: England, UK, 2019. [Google Scholar]
- R Core Team. R: A Language and Environment for Statistical Computing; R Foundation for Statistical Computing: Vienna, Austria, 2021. [Google Scholar]
- Botton, A.; Cúnico, S.D.; Strey, M.N. Diferença de gênero no acesso aos serviços de saúde. Mudanças 2017, 25, 67–72. [Google Scholar]
- Araujo, M.O.; Nascimento, M.A.A.; Araujo, B.O. Dinâmica organizativa do acesso dos usuários aos serviços de saúde de média e alta complexidade. Rev. APS 2019, 22. [Google Scholar] [CrossRef]
- Vianna, S.M. Atenção de Alta Complexidade no SUS: Desigualdades no Acesso e no Financiamento; MS/IPEA: Brasília, Brasil, 2005.
- Viáfora-López, C.A.; Quejada, G.; Obregón, A. Ethnic-racial inequity in health insurance in Colombia: A cross-sectional study. Rev. Panam Salud Publica 2021, 45, e77. [Google Scholar]
- Viana, A.L.D.; Bousquat, A.; Pereira, A.P.C.M.; Uchimura, L.Y.T.; Albuquerque, M.V.; Mota, P.H.S.; Demarzo, M.M.P.; Ferreira, M.P. Tipologia das regiões de saúde: Condicionantes estruturais para regionalização no Brasil. Saúde Soc. 2015, 24, 413–422. [Google Scholar]
- Fonseca, B.P.; Albuquerque, P.; Saldanha, R.; Zicker, F. Geographic accessibility to câncer treatment in Brazil: A network analysis. Lancet 2022, 7, 100153. [Google Scholar]
- Curtis, L.J. An economic perspective on the causal explanations for the socioeconomic inequalities in health. Rev. Panam Salud Publica 2018, 42, e53. [Google Scholar]
Distribution | Link | AIC | BIC |
---|---|---|---|
Gamma | Identity | - | - |
Log | 12,832,709 | 12,841,476 | |
Inverse | 13,364,347 | 13,373,114 | |
Inverse Normal | 25,169,339 | 25,178,106 | |
Inverse | - | - | |
Identity | - | - | |
Log | - | - | |
Normal | Identity | 14,293,630 | 14,302,397 |
Log | 14,283,706 | 14,292,472 | |
Inverse | 14,841,614 | 14,832,848 |
Spending per Capita (R$) | Spending per Ocurrence (R$) | |||||
---|---|---|---|---|---|---|
UF | 2010 | 2019 | % | 2010 | 2019 | % |
AC | 1.45 | 5.49 | 277.61 | 2484.74 | 5477.91 | 120.46 |
AL | 20.56 | 50.47 | 145.49 | 4328.49 | 4979.58 | 15.04 |
AM | 15.06 | 27.89 | 85.21 | 3976.76 | 4281.97 | 7.67 |
AP | 2.13 | 4.39 | 105.72 | 4882.35 | 6190.60 | 26.80 |
BA | 96.21 | 238.88 | 148.30 | 4011.92 | 5631.22 | 40.36 |
CE | 100.72 | 197.92 | 96.50 | 4611.92 | 6408.47 | 38.95 |
DF | 41.38 | 68.74 | 66.11 | 4551.04 | 5126.11 | 12.64 |
ES | 50.19 | 113.25 | 125.64 | 4629.67 | 5296.83 | 14.41 |
GO | 65.22 | 128.18 | 96.55 | 4957.23 | 5653.87 | 14.05 |
MA | 25.90 | 57.62 | 122.52 | 4048.72 | 4454.41 | 10.02 |
MG | 290.23 | 593.33 | 104.43 | 5017.94 | 5812.12 | 15.83 |
MS | 32.26 | 59.15 | 83.37 | 4925.28 | 4564.77 | −7.32 |
MT | 20.56 | 30.05 | 46.17 | 5420.39 | 5143.32 | −5.11 |
PA | 28.15 | 69.25 | 146.00 | 4967.69 | 5030.85 | 1.27 |
PB | 31.50 | 65.45 | 107.79 | 3612.76 | 5690.21 | 57.50 |
PE | 101.92 | 265.03 | 160.03 | 3781.68 | 5002.63 | 32.29 |
PI | 23.98 | 47.05 | 96.17 | 3600.04 | 4949.21 | 37.48 |
PR | 288.11 | 633.51 | 119.88 | 5254.60 | 5586.19 | 6.31 |
RJ | 147.43 | 255.26 | 73.14 | 4731.12 | 4941.76 | 4.45 |
RN | 47.30 | 95.96 | 102.87 | 4921.04 | 4969.86 | 0.99 |
RO | 1.62 | 12.74 | 686.87 | 2460.41 | 2992.51 | 21.63 |
RR | 1.56 | 1.25 | −19.80 | 2284.67 | 2034.87 | −10.93 |
RS | 263.31 | 436.89 | 65.92 | 4693.58 | 5199.36 | 10.78 |
SC | 132.35 | 285.87 | 116.00 | 5091.97 | 5683.73 | 11.62 |
SE | 12.54 | 25.59 | 104.14 | 5385.00 | 6314.35 | 17.26 |
SP | 836.34 | 1184.85 | 41.67 | 5032.61 | 5166.23 | 2.66 |
TO | 12.85 | 15.12 | 17.67 | 3387.54 | 4354.69 | 28.55 |
Total Spending (R$1,000,000.00) | Spending per Ocurrence (R$) | |||||
---|---|---|---|---|---|---|
Ethnicity/Skin Color | 2010 | 2019 | % | 2010 | 2019 | % |
White | 1358.57 | 2378.41 | 75.07 | 4982.87 | 5393.62 | 8.24 |
Black | 93.00 | 205.07 | 120.52 | 4449.19 | 5412.03 | 21.64 |
Indigenous | 3.28 | 1.54 | −53.13 | 4934.02 | 3829.03 | −22.40 |
Brown | 506.05 | 1577.45 | 211.72 | 4540.40 | 5312.85 | 17.01 |
Yellow | 16.59 | 57.34 | 245.65 | 3835.45 | 4574.18 | 19.26 |
Not determined | 713.37 | 749.39 | 5.05 | 4680.99 | 5261.48 | 12.40 |
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Martins, L.O.M.; dos Reis, M.F.; Chaoubah, A.; Rego, G. Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010–2019. Int. J. Environ. Res. Public Health 2023, 20, 3006. https://doi.org/10.3390/ijerph20043006
Martins LOM, dos Reis MF, Chaoubah A, Rego G. Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010–2019. International Journal of Environmental Research and Public Health. 2023; 20(4):3006. https://doi.org/10.3390/ijerph20043006
Chicago/Turabian StyleMartins, Luiz Oscar Machado, Marcio Fernandes dos Reis, Alfredo Chaoubah, and Guilhermina Rego. 2023. "Ethnic-Regional Differences in the Allocation of High Complexity Spending in Brazil: Time Analysis 2010–2019" International Journal of Environmental Research and Public Health 20, no. 4: 3006. https://doi.org/10.3390/ijerph20043006