Expenses of hospitalization for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo

Dias, Bruna Moreno; Zanetti, Ariane Cristina Barboza; Pereira, Antonio Carlos

doi:10.31744/einstein_journal/2021GS5817

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Health Economics and Management • Einstein (São Paulo) 19 • 2021 • https://doi.org/10.31744/einstein_journal/2021GS5817 copy

Expenses of hospitalization for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the expenses of hospitalizations for ambulatory care sensitive conditions in the Health Regional Offices of the State of São Paulo.

Methods:

An ecological, retrospective cohort, with analysis of hospital admissions for ambulatory care sensitive conditions in the state of São Paulo, from 2014 to 2018, compiled by the Hospital Information System. Data were extracted using the Tabwin application and analyzed using descriptive statistics.

Results:

There was a 14.49% reduction in the amount spent on hospitalizations for ambulatory care sensitive conditions. There were reductions in the frequency of hospitalizations (−1.26) and hospital stay (−0.54), and an increase in the occurrence of deaths (8.02). The Regional Offices of Barretos, Taubaté and Araraquara showed an increase in expenses in the period, by 37.86%, 15.38% and 3.78%, respectively, while all other Regional Offices showed a reduction; in that, the most significant were in Bauru (−31.90%), São João da Boa Vista (−26.18%), Presidente Prudente (−21.00%) and São Paulo (−19.17%). The value of hospitalizations for ambulatory care sensitive conditions showed a strong and positive correlation with the variables frequency and hospital stay.

Conclusion:

The results pointed to a difference in the amounts spent on hospitalizations for ambulatory care sensitive conditions in the Regional Offices, although there was no difference in the frequency and duration of these hospitalizations. The expansion of Primary Health Care resources is a possible element for reducing the frequency and spending on hospitalizations for ambulatory care sensitive conditions; nonetheless, it is necessary to consider other factors, such as social determinants and the organization of health services.

Keywords:
Primary Health Care; Hospitalization; Hospital costs; Health expenditures; Regional health planning

Year	Hospitalizations for ACSC	General hospital admissions	Proportion of hospitalizations for ACSC (%)	Population	Hospitalizations for ACSC rate (per thousand)
2014	377,988	2,496,141	15.14	43,937,755	8.60
2015	377,752	2,493,368	15.15	44,356,304	8.52
2016	372,974	2,489,614	14.98	44,760,305	8.33
2017	373,069	2,498,888	14.93	45,149,603	8.26
2018	373,241	2,538,337	14.70	45,538,936	8.20

Heath regional offices	Frequency				Value (R$)				Length of hospital stay				Death
Heath regional offices	2014	2018	Variation(%)	p value^* * Wilcoxon paired test, statistical significance considered for p<0.05	2014^† † 2014 value adjusted for inflation in the period	2018	Variation(%)	p value^* * Wilcoxon paired test, statistical significance considered for p<0.05	2014	2018	Variation(%)	p value^* * Wilcoxon paired test, statistical significance considered for p<0.05	2014	2018	Variation(%)	p value^* * Wilcoxon paired test, statistical significance considered for p<0.05
Greater São Paulo	151,404	154,241	1.87	0.717	225,575,520.73	182,330,045.28	−19.17	0.005^‡ ‡ p<0.05.	1,107,765	1,050,257	−5.19	0.398	9,167	9,991	8.99	0.396
Araçatuba	9,179	8,505	−7.34	0.794	8,696,477.00	8,522,201.50	−2.00	0.198	39,109	41,163	5.25	0.421	584	625	7.02	0.849
Araraquara	10,418	11,489	10.28	0.121	14,189,798.98	14,726,521.44	3.78	0.277	76,060	69,921	−8.07	0.184	746	778	4.29	0.192
Baixada Santista	10,470	9,914	−5.31	0.494	12,191,048.68	12,117,636.75	−0.60	0.968	73,034	75,188	2.95	0.778	930	1,109	19.25	0.067
Barretos	5,425	5,197	−4.20	0.184	3,688,118.69	5,084,465.88	37.86	0.024^‡ ‡ p<0.05.	21,402	26,623	24.39	0.103	272	362	33.09	0.199
Bauru	23,963	19,894	−16.98	0.014^‡ ‡ p<0.05.	30,225,019.28	20,583,674.20	−31.90	0.005^‡ ‡ p<0.05.	132,591	120,284	−9.28	0.147	1,488	1,306	−12.23	0.133
Campinas	29,171	30,844	5.74	0.117	39,535,158.53	34,331,818.73	−13.16	0.126	174,020	190,628	9.54	0.036^‡ ‡ p<0.05.	1,806	1,855	2.71	0.672
Franca	7,024	6,965	−0.84	0.717	10,141,339.43	8,417,055.31	−17.00	0.243	30,425	30,921	1.63	0.872	477	387	−18.87	0.033^‡ ‡ p<0.05.
Marília	16,616	15,180	−8.64	0.334	17,601,805.86	15,780,963.18	−10.34	0.030^‡ ‡ p<0.05.	83,783	88,190	5.26	0.376	1,026	1,001	−2.44	0.460
Piracicaba	10,146	9,010	−11.20	0.067	16,382,931.56	13,300,291.47	−18.82	0.126	56,661	52,696	−7.00	0.376	720	731	1.53	0.536
Presidente Prudente	13,314	13,512	1.49	0.841	14,014,865.71	11,071,972.62	−21.00	0.099	60,237	61,590	2.25	0.546	733	712	−2.86	0.950
Registro	1,911	1,810	−5.29	0.931	1,493,468.36	1,376,145.93	−7.86	0.687	10,682	11,551	8.14	0.171	273	354	29.67	0.043^‡ ‡ p<0.05.
Ribeirão Preto	15,184	15,744	3.69	0.421	26,336,769.31	22,298,947.30	−15.33	0.005^‡ ‡ p<0.05.	88,465	94,897	7.27	0.243	834	842	0.96	0.652
São João da Boa Vista	10,557	9,138	−13.44	0.023^‡ ‡ p<0.05.	8,568,923.81	6,325,339.92	−26.18	<0.001^‡ ‡ p<0.05.	47,913	45,956	−4.08	0.520	850	719	−15.41	0.170
São José do Rio Preto	26,039	23,477	−9.84	0.212	37,273,150.84	34,250,673.03	−8.11	0.968	109,751	115,225	4.99	0.629	924	1,440	55.84	0.024^‡ ‡ p<0.05.
Sorocaba	18,265	17,112	−6.31	0.573	20,268,370.15	17,507,823.74	−13.62	0.070	85,730	93,699	9.30	0.398	1,657	1,770	6.82	0.338
Taubaté	18,902	21,209	12.21	0.243	25,885,826.35	29,866,293.97	15.38	0.968	146,653	162,927	11.10	0.084	1,434	1,858	29.57	0.016^‡ ‡ p<0.05.
Total	377,988	373,241	−1.26	0.435	512,068,592.46	437,891,870.25	−14.49	0.010^‡ ‡ p<0.05.	2,344,281	2,331,716	−0.54	0.266	23,921	25,840	8.02	0.107

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[1] Corresponding author: Bruna Moreno Dias, Avenida Bandeirantes, 3.900 Campus Universitário Zip code: 14040-902 – Ribeirão Preto, SP, Brazil, Phone: (55 16) 3315-3471 E-mail: bruna.dias@usp.br