Gastos com saúde e <i>causa mortis</i>: uma investigação dos municípios do Estado do Paraná, Brasil

Feldens, Tallys Kalynka; Souza, Kênia Barreiro de

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Cadernos de Saúde Pública

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ARTICLE • Cad. Saúde Pública 38 (7) • 2022 • https://doi.org/10.1590/0102-311XEN272421 copiar

Gastos com saúde e causa mortis: uma investigação dos municípios do Estado do Paraná, Brasil

Autoria SCIMAGO INSTITUTIONS RANKINGS

O financiamento da saúde pública é uma responsabilidade compartilhada entre as três esferas governamentais brasileiras, i.e., a federal, estadual e municipal. Logo, gastos divergem pelo território e não se poderia esperar que contribuíssem de forma homogênea para os desfechos de saúde em todos os tipos de doença. Este artigo busca identificar como gastos municipais afetam a taxa de mortalidade no Estado do Paraná dado sua causa mortis. Consideramos anos de vida perdidos para cada município, os capítulos da Classificação Internacional de Doenças (10ª revisão) e estimamos a elasticidade dessa medida em relação aos gastos públicos em saúde. Considerando uma possível endogeneidade, este artigo segue a abordagem variável instrumental em um painel de método generalizado de momentos (GMM-IV) com efeitos fixos. Nossos resultados mostram que um aumento de 1% nos gastos municipais com saúde pode diminuir o número médio de anos perdidos entre 0,176% e 1,56% para algumas causas especificas de mortalidade. Nosso estudo pode lançar alguma luz sobre a perspectiva política das finanças dos estados.

Palavras-chave:
Financiamento da Assistência à Saúde; Orçamentos; Anos de Vida Perdidos; CID-10; Recursos em Saúde

ICD-10 (chapter)	Deaths		YLL (mean)	YLL (sum)
ICD-10 (chapter)	n	%
I. Certain infectious and parasitic diseases	11,663	3	433.27	864,381.28
II. Neoplasms	69,241	19	730.91	1,458,158.14
III. Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism	1,441	0	52.55	104,832.39
IV. Endocrine, nutritional, and metabolic diseases	21,800	6	218.96	436,825.75
V. Mental and behavioral disorders	4,064	1	68.58	136,822.37
VI. Diseases of the nervous system	13,156	4	96.22	191,965.02
VII. Diseases of the eye and adnexa	0	0	0.00	0.00
VIII. Diseases of the ear and mastoid process	34	0	172.00	343,139.62
IX. Diseases of the circulatory system	102,624	28	727.63	1,451,612.77
X. Diseases of the respiratory system	43,720	12	301.01	600,509.99
XI. Diseases of the digestive system	19,412	5	160.95	321,092.73
XII. Diseases of the skin and subcutaneous tissue	793	0	9.09	18,128.37
XIII. Diseases of the musculoskeletal system and connective tissue	1,617	0	29.00	57,849.54
XIV. Diseases of the genitourinary system	8,909	2	58.11	115,927.75
XV. Pregnancy, childbirth, and the puerperium	393	0	43.61	86,997.24
XVI. Certain conditions originating in the perinatal period	4,926	1	172.22	343,574.97
XVII. Congenital malformations, deformations, and chromosomal abnormalities	3,084	1	109.73	218,905.33
XVIII. Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified	10,799	3	258.71	516,123.69
XIX. Injury, poisoning, and certain other consequences of external causes	0	0	0.00	0.00
XX. External causes of morbidity and mortality	43,518	12	574.44	1,146,012.90
Total	361,194	100	4,216.97	8,412,859.85

Variables	ICD-10 chapter
Variables	I	II	III	IV	V	VI	VIII	IX	X
logdesp	-0.176 *	-0.520 **	-0.108	-0.234 *	-0.172	-0.0763 ***	-0.00795	-0.0470	-0.0424 ***
	(0.0849)	(0.147)	(0.0686)	(0.106)	(0.135)	(0.0395)	(0.0182)	(0.108)	(0.0251)
logdens	0.119 ***	0.537 *	0.0411	0.216	0.0257	0.0177	0.0264	0.147 ***	0.00770
	(0.0608)	(0.216)	(0.0669)	(0.132)	(0.143)	(0.0368)	(0.0237)	(0.0846)	(0.0229)
logimuni	0.00169	-0.065 **	0.0236 ***	0.0412 ***	-0.0445 ***	0.00888	-0.00267	-0.0128	-0.00268
	(0.0138)	(0.0206)	(0.0132)	(0.0219)	(0.0227)	(0.0101)	(0.0112)	(0.0141)	(0.00740)
logprofi	0.0143	-0.0119	-0.0392	-0.0237	0.0514	-0.00417	0.00484	-0.0192	-0.00833
	(0.0484)	(0.0561)	(0.0300)	(0.0434)	(0.0560)	(0.0184)	(0.0156)	(0.0334)	(0.0121)
GV_A	-0.00699	0.0917	-0.0730 *	-0.0357	-0.0293	-0.0509	-0.0515 *	0.0141	0.00658
	(0.0330)	(0.0563)	(0.0332)	(0.0443)	(0.0544)	(0.0316)	(0.0235)	(0.0334)	(0.0137)
GV_I	0.0215	0.0342	-0.0143	-0.0263	0.0187	-0.0151	-0.0145 ***	-0.000225	0.00755
	(0.0198)	(0.0384)	(0.0149)	(0.0251)	(0.0312)	(0.0107)	(0.00798)	(0.0216)	(0.00733)
GV_S	-0.00596	-0.0281	-0.0295	-0.0226	0.0677	-0.0288	-0.0345 ***	-0.0546	-0.00366
	(0.0374)	(0.0846)	(0.0362)	(0.0561)	(0.0823)	(0.0246)	(0.0204)	(0.0423)	(0.0129)
GV_pub	-0.174 *	-0.855 **	-0.0293	0.0365	-0.0456	0.0172	0.0230	-0.195 *	-0.0218
	(0.0817)	(0.165)	(0.0772)	(0.123)	(0.144)	(0.0590)	(0.0375)	(0.0860)	(0.0296)
GDP_pc	0.0454	-0.193	0.0918	0.0984	-0.0495	0.124 ***	0.105 ***	0.0852	-0.0226
	(0.0728)	(0.153)	(0.0777)	(0.106)	(0.138)	(0.0718)	(0.0539)	(0.0770)	(0.0428)
ideb	-6.37e-05	-0.000427	-0.000106	0.000661	-0.000879	-0.000220	-0.000262	0.000904	-0.000103
	(0.00055)	(0.00208)	(0.00040)	(0.00072)	(0.00078)	(0.00037)	(0.00025)	(0.00064)	(0.00015)
2016_on	0.0167	-0.0708 *	0.0216	-0.0359	-0.00314	0.00918	-0.00387	-0.0327 *	0.0111
	(0.0190)	(0.0282)	(0.0144)	(0.0229)	(0.0261)	(0.0140)	(0.00812)	(0.0160)	(0.0117)
t_id	0.024 **	0.190 **	0.00840	0.032 **	0.0152	-0.00136	-0.000766	0.032 **	0.00340
	(0.00779)	(0.0153)	(0.00769)	(0.0115)	(0.0152)	(0.00562)	(0.00268)	(0.0111)	(0.00302)
Observations	1,990	1,990	1,990	1,990	1,990	1,990	1,990	1,990	1,990
Municipalities	399	399	399	399	399	399	399	399	399
R-squared	-0.087	-0.033	-0.031	-0.064	-0.008	-0.030	0.006	0.013	-0.004

Variables	ICD-10 chapter
Variables	XI	XII	XIII	XIV	XV	XVI	XVII	XVIII	XX
logdesp	-0.272 *	-0.0686 **	0.0545	-0.0487 **	-0.164	-1.563 ***	-0.702 ***	0.0825	-0.0600
	(0.105)	(0.0354)	(0.0504)	(0.0271)	(0.263)	(0.618)	(0.275)	(0.0846)	(0.178)
logdens	0.0850	0.121	-0.0220	-0.00695	0.573	1.338 **	0.617 **	-0.0281	0.0702
	(0.134)	(0.0854)	(0.0317)	(0.0353)	(0.357)	(0.734)	(0.321)	(0.0729)	(0.149)
logimuni	-0.00742	0.00380	-0.00870	0.000518	-0.0128	-0.577 *	-0.0540	0.00146	-0.0307
	(0.0164)	(0.00772)	(0.00655)	(0.00782)	(0.0510)	(0.101)	(0.0370)	(0.0152)	(0.0330)
logprofi	-0.0608	-0.00575	0.00320	-0.00648	0.107	0.372	0.0705	-0.00428	-0.0895
	(0.0437)	(0.0123)	(0.00592)	(0.0106)	(0.109)	(0.237)	(0.0959)	(0.0314)	(0.0685)
GV_A	0.0130	-0.0563 ***	0.0498	-0.0226	0.0393	0.424 **	0.133	0.0818 ***	0.0120
	(0.0388)	(0.0245)	(0.0401)	(0.0271)	(0.145)	(0.234)	(0.0954)	(0.0377)	(0.0606)
GV_I	0.0258	-0.0179 ***	0.0115	-0.00651	0.0341	-0.105	0.0811	0.0182	0.00444
	(0.0239)	(0.00825)	(0.00966)	(0.00794)	(0.0643)	(0.152)	(0.0596)	(0.0195)	(0.0545)
GV_S	-0.0963 **	-0.0194	0.0329	-0.0226	0.221	0.251	-0.0402	0.0586	-0.00896
	(0.0545)	(0.0196)	(0.0268)	(0.0172)	(0.209)	(0.342)	(0.141)	(0.0371)	(0.114)
GV_pub	-0.251 ***	-0.00346	-0.0283	0.0982 ***	-0.261	-4.148 *	-1.259 *	-0.117	-0.490 ***
	(0.109)	(0.0495)	(0.0638)	(0.0426)	(0.276)	(0.651)	(0.268)	(0.0855)	(0.229)
GDP_pc	0.104	0.117 ***	-0.125	0.0933	-0.414	-0.236	-0.0543	-0.147 ***	0.00902
	(0.0957)	(0.0574)	(0.101)	(0.0611)	(0.335)	(0.619)	(0.252)	(0.0740)	(0.165)
ideb	0.00166	5.16e-05	2.30e-05	1.82e-05	0.000577	-0.00407	0.00116	0.000378	0.00449
	(0.00186)	(0.00016)	(0.00011)	(0.00019)	(0.00155)	(0.00980)	(0.00268)	(0.00036)	(0.00503)
2016_on	-0.0294	0.00908	0.000106	-0.0212 **	-0.0118	0.625 *	-0.0935 ***	-0.0203	0.0265
	(0.0192)	(0.0102)	(0.00576)	(0.0119)	(0.0576)	(0.123)	(0.0445)	(0.0138)	(0.0400)
t_id	0.059 *	-0.000378	0.00203	-0.00244	0.0520 **	0.381 *	0.234 *	0.0144 **	0.0437 ***
	(0.0113)	(0.00472)	(0.00391)	(0.00451)	(0.0291)	(0.0641)	(0.0281)	(0.00797)	(0.0190)
Observstions	1,990	1,990	1,990	1,990	1,990	1,990	1,990	1,990	1,990
Municipalities	399	399	399	399	399	399	399	399	399
R-squared	-0.107	-0.026	-0.009	0.001	-0.000	0.007	-0.056	0.000	0.007

DISEASE	THIS STUDY	MARTIN ET AL. ²²22. Martin S, Rice N, Smith P. Does health care spending improve health outcomes? Evidence from English programme budgeting data. J Health Econ 2008; 27:826-42.	MARTIN ET AL. ²³23. Martin S, Rice N, Smith P. Comparing costs and outcomes across programmes of health care. Health Econ 2012; 21:316-37.	CLAXTON ET AL. ¹²12. Claxton K, Lomas J, Martin S. The impact of NHS expenditure on health outcomes in England: alternative approaches to identification in all-cause and disease specific models of mortality. Health Econ 2018; 27:1017-23.
Cancer	Significant and negative (-0.520)	Significant and negative (-0.378)	Significant and negative (-0.393)	Significant and negative (-0.282)
Diabetes	Significant and negative (-0.234)	N/C	Significant and negative (-1.427)	N/C
Neurological diseases	Not significant	N/C	Not Significant	N/C
Cardiovascular diseases	Not significant	Significant and negative (-1.427)	Significant and negative (-1.585)	Significant and negative (-2.450)
Respiratory diseases	Not significant	N/C	Significant and negative, with caveats	Significant and negative (-2.194)
Gastrointestinal diseases	Significant and negative (-0.272)	N/C	Significant and negative (-2.018)	Significant and negative (-2.888)
Genitourinary diseases	Not significant	N/C	Contradictory results	N/C

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

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[1] Correspondence
T. K. Feldens Rua Brasílio Itiberê 1345, apto. 1202, Curitiba, PR 80215-140, Brasil. feldens.tallys@gmail.com