The unified health system of Brazil and the effectiveness of health services
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ORIGINAL ARTICLE
The unified health system of Brazil and the effectiveness of health services Rafael da Silva Barbosa 1
&
Eduardo Fagnani 2
Received: 12 March 2020 / Accepted: 15 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Public policy . Unified health system . Effectiveness . Brazil JEL Classification I11 . I13 . C01
Key messages (highlights) The number of public and private treatments increased in Medium Complexity and High Complexity; the hospital admissions are higher at Medium Complexity for the public, while private ones are for High Complexity; as estimated, the model data suggest that the public health sector is twice as effectiveness as the private sector. * Rafael da Silva Barbosa [email protected] Eduardo Fagnani [email protected] 1
Social Policy and Health Economics, Universidade Federal do Espírito Santo, Av. Fernando Ferrari, 514, Vitória, ES 29075-910, Brazil
2
Economic Development and Social Policy, Universidade Estadual de Campinas, R. Pitágoras, 353 - Cidade Universitária, Campinas, SP 13083-857, Brazil
Introduction The issue of spending performance is a recurring theme in economic analysis. It evaluates which interventions best generate wealth and which represent wasteful spending. In general, the evaluation assumptions
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