Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

doi:10.1590/S0034-8910.2015049005696

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Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005696 linkcopy

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil.

METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness.

RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients.

CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

Hospitalization; Hospitals, Municipal, supply & distribution; Migration; Regional Health Planning; Equity in Access

Health Regions	Population	Population in the hub city	% Population in the hub	Total resident hospitalizations	Beds/1,000 population rate	Coefficient of hospitalization per 1,000 inhabitants (residence/population)
3501 Greater Sao Paulo	19,677,510	10,603,309	53.9	1,168,968	1.36	59.41
3502 Aracatuba	700,008	174,770	25.0	55,645	2.12	79.49
3503 Araraquara	915,240	192,153	21.0	74,223	1.52	81.1
3504 Baixada Santista	1,666,453	402,664	24.2	116,692	1.46	70.02
3505 Barretos	412,722	106,048	25.7	43,081	2.55	104.38
3506 Bauru	1,623,025	343,285	21.1	153,389	2.45	94.51
3507 Campinas	3,885,612	1,019,655	26.2	273,450	1.19	70.38
3508 Franca	657,344	315,795	48.0	55,075	1.57	83.78
3509 Marilia	1,081,290	215,673	19.9	111,738	2.36	103.34
3510 Piracicaba	1,405,849	352,684	25.1	85,089	1.31	60.52
3511 Presidente Prudente	723,244	198,937	27.5	80,297	2.41	111.02
3512 Registro	299,360	55,141	18.4	13,462	1.03	44.97
3513 Ribeirao Preto	1,261,413	538,639	42.7	88,713	1.82	70.33
3514 Sao Joao da Boa Vista	797,952	80,334	10.1	83,692	2.05	104.88
3515 Sao Jose do Rio Preto	1,459,320	399,904	27.4	186,250	2.49	127.63
3516 Sorocaba	2,245,623	556,366	24.8	168,920	1.24	75.22
3517 Taubate	2,243,796	261,454	11.6	133,470	1.42	59.48
Total	41,055,761	15,816,811	38.5	2,892,154	1.53	70.44

Health regions	SUS hospitalizations by service location (C)		Total resident hospitalizations (D)	Hospitalizations in the place of origin (E)		Immigration cases (F)		Emigration cases (G)		Index of migration effectiveness (H)
Health regions	n	%	Total resident hospitalizations (D)	n	%	n	%	n	%	Index of migration effectiveness (H)
3501 Greater Sao Paulo	834,367	70.5	821,626	816,707	99.4	17,660	2.1	4,919	0.6	0.56
3502 Aracatuba	44,840	86.8	47,117	44,370	94.2	470	1.0	2,747	5.8	-0.71
3503 Araraquara	47,057	66.5	49,966	46,612	93.3	445	0.9	3,354	6.7	-0.77
3504 Baixada Santista	75,347	66.2	77,121	74,569	96.7	778	1.0	2,552	3.3	-0.53
3505 Barretos	35,205	74.7	29,531	27,992	94.8	7,213	20.5	1,539	5.2	0.65
3506 Bauru	124,326	75.0	112,994	111,427	98.6	12,899	10.4	1,567	1.4	0.78
3507 Campinas	179,028	62.2	174,807	170,262	97.4	8,766	4.9	4,545	2.6	0.32
3508 Franca	34,050	64.2	36,016	33,810	93.9	240	0.7	2,206	6.1	-0.80
3509 Marilia	78,919	72.9	82,005	78,466	95.7	453	0.6	3,539	4.3	-0.77
3510 Piracicaba	59,262	72.0	62,199	58,298	93.7	964	1.6	3,901	6.3	-0.60
3511 Presidente Prudente	49,215	61.4	50,122	48,915	97.6	300	0.6	1,207	2.4	-0.60
3512 Registro	11,729	95.8	12,731	11,579	91.0	150	1.3	1,152	9.0	-0.77
3513 Ribeirao Preto	71,734	76.4	67,247	66,220	98.5	5,514	7.7	1,027	1.5	0.69
3514 Sao Joao da Boa Vista	53,505	66.1	56,639	52,449	92.6	1,056	2.0	4,190	7.4	-0.60
3515 Sao Jose do Rio Preto	113,262	58.3	111,737	109,302	97.8	3,960	3.5	2,435	2.2	0.24
3516 Sorocaba	123,793	74.4	125,766	121,252	96.4	2,541	2.1	4,514	3.6	-0.28
3517 Taubate	106,506	81.0	107,498	104,545	97.3	1,961	1.8	2,953	2.7	-0.20
Total	2,042,145	69.9	2,025,122	1,976,775	97.6	65,370	3.2	48,347	2.4	0.15

Health regions	Total private system hospitalizations by service location (C)		Total resident hospitalization (D)	Hospitalizations in the place of origin (E)		Immigration cases (F)		Emigration cases (G)		Index of migration effectiveness (H)
Health regions	n	%	Total resident hospitalization (D)	n	%	n	%	n	%	Index of migration effectiveness (H)
3501 Greater Sao Paulo	348,423	29.5	347,342	335,934	96.7	12,489	3.6	11,408	3.3	0.05
3502 Aracatuba	6,815	13.2	8,528	6,615	77.6	200	2.9	1,913	22.4	-0.81
3503 Araraquara	23,690	33.5	24,257	22,405	92.4	1,285	5.4	1,852	7.6	-0.18
3504 Baixada Santista	38,454	33.8	39,571	38,013	96.1	441	1.1	1,558	3.9	-0.56
3505 Barretos	11,923	25.3	13,550	11,571	85.4	352	3.0	1,979	14.6	-0.70
3506 Bauru	41,401	25.0	40,395	38,957	96.4	2,444	5.9	1,438	3.6	0.26
3507 Campinas	108,733	37.8	98,643	95,863	97.2	12,870	11.8	2,780	2.8	0.64
3508 Franca	18,973	35.8	19,059	18,345	96.3	628	3.3	714	3.7	-0.06
3509 Marilia	29,272	27.1	29,733	27,832	93.6	1,440	4.9	1,901	6.4	-0.14
3510 Piracicaba	23,077	28.0	22,890	20,918	91.4	2,159	9.4	1,972	8.6	0.05
3511 Presidente Prudente	30,964	38.6	30,175	29,330	97.2	1,634	5.3	845	2.8	0.32
3512 Registro	519	4.2	731	503	68.8	16	3.1	228	31.2	-0.87
3513 Ribeirao Preto	22,181	23.6	21,466	20,861	97.2	1,320	6.0	605	2.8	0.37
3514 Sao Joao da Boa Vista	27,390	33.9	27,053	25,390	93.9	2,000	7.3	1,663	6.1	0.09
3515 Sao Jose do Rio Preto	81,149	41.7	74,513	74,033	99.4	7,116	8.8	480	0.6	0.87
3516 Sorocaba	42,569	25.6	43,154	41,256	95.6	1,313	3.1	1,898	4.4	-0.18
3517 Taubate	24,970	19.0	25,972	24,164	93.0	806	3.2	1,808	7.0	-0.38
Total	880,503	30.1	867,032	831,990	96.0	48,513	5.5	35,042	4.0	0.16

Health Regions	Flow balance		Strong flow attraction		Strong flow emigration
Health Regions	Public	Private	Public	Private	Public	Private
Greater Sao Paulo		X	X
Aracatuba					X	X
Araraquara		X			X
Baixada Santista					X	X
Barretos			X			X
Bauru		X	X
Campinas	X			X
Franca		X			X
Marilia		X			X
Piracicaba		X			X
Presidente Prudente		X			X
Registro					X	X
Ribeirao Preto		X	X
Sao Joao da Boa Vista		X			X
Sao Jose do Rio Preto	X			X
Sorocaba	X	X
Taubate	X	X

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