Health policies and federative gaps in Brazil: an analysis of regional capacity of services delivery

Ribeiro, José Mendes; Moreira, Marcelo Rasga; Ouverney, Assis Mafort; Silva, Cosme Marcelo Furtado Passos da

doi:10.1590/1413-81232017224.03732017

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ARTICLE • Ciênc. saúde colet. 22 (4) • Apr 2017 • https://doi.org/10.1590/1413-81232017224.03732017 copy

Health policies and federative gaps in Brazil: an analysis of regional capacity of services delivery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper analyzes Brazilian health regions according to their service delivery capacity from the debate on the crisis of cooperative federalism in the SUS that resulted from decentralizing process established in the 1988 Constitution. Service delivery capacity tracer indicators were selected by regions and statistical analyses evidenced greater regional capacity in hospital care and large asymmetries with regard to the availability of physicians, high complexity equipment and private insurance coverage. In conclusion,we argue that further solutions are required to strengthen governmental capacity to reduce regional inequalities throughincreased central coordination.

Health regions; Service delivery; Federalism

UF	Did not migrate	Did not migrate (total AIH)	Migrated (total AIH)	AIH not identified	Total AIH	Average values of non-migration AIH	Average values of migration AIH
AM	98,8	165.319	2.015	0	167.334	766,22	1.133,14
MS	97,2	161.341	4.724	1	166.066	963,07	2.750,39
RJ	94,9	638.697	34.007	4	672.708	1.018,77	1.991,63
RR	93,0	31.506	2.379	0	33.885	627,71	741,62
PA	92,8	463.006	35.990	3	498.999	626,84	1.401,96
MT	92,0	171.004	14.842	3	185.849	761,25	1.787,55
AC	91,9	47.523	4.213	0	51.736	628,64	885,62
DF	91,0	172.278	16.991	0	189.269	954,75	1.316,97
ES	90,9	197.344	19.790	2	217.136	1.036,90	1.709,73
MA	90,4	373.592	39.791	7	413.390	614,52	1.456,03
PR	90,2	695.615	75.149	17	770.781	1.182,75	2.635,70
RO	90,1	96.644	10.652	0	107.296	566,71	1.098,27
SC	89,4	377.020	44.756	0	421.776	1.217,07	2.552,11
BA	89,1	715.759	87.378	15	803.152	750,59	1.648,55
SP	87,4	2.160.758	309.994	320	2.471.072	1.105,08	2.411,10
RS	87,2	651.592	95.419	8	747.019	1.095,50	2.689,94
AP	86,7	33.131	5.084	0	38.215	618,18	712,12
MG	85,0	1.021.765	180.924	12	1.202.701	1.081,71	2.281,12
PI	84,1	186.307	35.081	11	221.399	631,67	1.372,01
GO	83,9	301.655	57.936	98	359.689	871,57	1.992,93
CE	83,8	392.879	75.910	0	468.789	837,11	1.950,64
TO	83,4	88.160	17.555	7	105.722	724,28	1.439,12
PE	79,6	437.949	112.266	3	550.218	1.025,60	1.745,39
AL	77,4	137.022	39.987	1	177.010	880,12	1.238,04
PB	77,2	157.805	46.647	2	204.454	840,08	1.363,82
RN	76,8	127.288	38.388	2	165.678	946,20	1.677,88
SE	62,6	56.196	33.605	0	89.801	801,86	1.218,75
Total	87,5	10.059.155	1.441.473	516	11.501.144	858,32	1.674,15

ICD		Yes	No		Yes	No		Yes	No		Yes	No		Yes	No
I	Midwest	1.693,93	722,03	Northeast	1.600,75	591,23	South	2.391,22	1.224,67	North	1.350,39	517,29	Southeast	2.561,37	1.488,64
II		2.056,96	1.378,84		2.544,38	1.756,31		2.220,62	1.680,97		1.616,48	1.264,56		2.446,31	1.628,78
III		804,95	447,47		848,04	433,60		3.125,52	561,32		568,71	396,37		1.442,00	566,96
IV		933,55	438,95		955,07	494,93		3.539,22	893,83		971,37	494,70		2.060,60	595,53
V		894,53	827,81		1.056,76	994,75		1.013,49	865,96		777,22	651,51		1.053,40	959,60
VI		1.512,44	1.283,75		1.556,96	1.054,75		1.675,78	1.164,94		1.690,94	945,58		2.003,22	1.446,19
VII		1.825,04	988,83		1.168,77	1.014,16		1.577,84	1.215,88		1.068,90	1.140,94		1.156,01	861,94
VIII		4.328,07	1.677,04		4.935,78	2.422,47		3.985,48	976,90		3.441,69	400,23		7.058,87	1.664,73
IX		4.293,62	1.892,29		3.075,71	1.423,63		4.787,01	2.152,83		2.903,12	1.228,37		4.722,48	1.934,43
X		1.530,38	875,68		1.886,26	799,81		1.876,75	953,25		1.371,77	690,41		1.680,92	1.019,46
XI		1.086,64	704,40		1.396,77	703,42		2.291,02	927,62		970,96	609,77		2.123,40	898,86
XII		817,91	635,57		753,25	543,74		794,33	551,64		728,42	484,61		708,83	528,83
XIII		3.481,72	1.596,73		1.527,90	1.062,33		3.337,00	2.195,48		1.656,79	898,38		2.462,89	1.498,41
XIV		1.399,86	515,90		1.328,78	581,53		3.220,19	744,12		977,45	423,34		2.577,35	692,19
XV		667,16	553,29		662,72	557,48		586,32	562,72		630,74	541,51		661,01	570,82
XVI		4.677,08	2.034,57		3.088,49	1.936,34		6.977,24	3.606,46		2.840,82	1.448,12		5.524,22	2.640,26
XVII		3.778,75	3.074,23		3.230,94	2.343,81		4.404,47	2.460,16		3.210,84	1.535,18		4.067,66	2.374,50
XVIII		1.117,69	624,59		927,83	656,63		1.472,78	985,78		1.297,94	727,43		1.062,28	726,95
XIX		1.556,46	911,08		1.325,55	935,14		2.168,80	1.226,77		1.128,04	751,20		1.931,75	1.085,73
XX		1.213,54	440,59		631,17	403,37		2.821,04	1.040,63		773,55	440,89		1.147,06	826,87
XXI		476,31	277,77		559,74	349,64		1.242,09	460,58		265,93	265,71		1.116,28	440,48
XXII		-	-		-	-		-	-		-	-		66,32	-

Physicians*	North	Northeast	Southeast	South	Midwest	Brazil
Total	57.074	266.388	794.160	258.191	103.813	1.479.626
Mean	1.268,31	2.002,92	5.190,59	3.796,93	2.661,87	3.378,14
Median	457	700	1.865	1.923	683	1.186
Minimum	69	108	112	565	45	45
Maximum	12.503	35.720	139.554	34.774	19.280	139.554
Per million inhabitants	3.260,54	4.709,82	9.261,82	8.833,03	6.722,67	7.235,96

Private health insurance*	North	Northeast	Southeast	South	Midwest	Brazil

Total**	1.818.929	6.747.733	30.588.815	7.066.435	3.141.095	9.363.007
Mean	40.420,64	50.734,83	397.257,34	03.918,16	82.660,39	12.958,83
Median	7.220	6.725	50.977	40.069	18.053	23.093
Minimum	506	750	500	6.267	563	500
Maximum	548.818	1.101.750	30.588.815	1.389.922	938.043	6.470.086
Per 100 inhabitants	10,39	11,93	35,67	24,18	20,34	24,14
Population***	17.504.446	6.560.081	85.745.520	9.230.180	15.442.232	04.482.459

Variables	Correlation Coefficient (Spearman)
Total mammography	0,6779
Total MRI	0,7356
Total US	0,3204
Plans coverage	0,8760

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

Authors worked together on the design and outline of this paper; JM Ribeiro was responsible for writing this paper and analyzing and interpreting data; MR Moreira, AM Ouverney and CFP Silva were responsible for the critical review of the text.