Social Determinants, Conditions and Performance of Health Services in Latin American Countries, Portugal and Spain

Conill, Eleonor Minho; Xavier, Diego Ricardo; Piola, Sérgio Francisco; Silva, Silvio Fernandes da; Barros, Heglaucio da Silva; Báscolo, Ernesto

doi:10.1590/1413-81232018237.07992018

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ARTICLE • Ciênc. saúde colet. 23 (7) • July 2018 • https://doi.org/10.1590/1413-81232018237.07992018 copy

Social Determinants, Conditions and Performance of Health Services in Latin American Countries, Portugal and Spain

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Comparison can be an important resource for identifying trends or interventions that improve the quality of health services. Although Portugal and Spain have accumulated important knowledge in primary health care-PHC driven national systems, the Ibero-American countries have not been object of comparative studies. This paper presents an assessment using an analytical dashboard created by the Ibero-American Observatory on Policies and Health Systems. It discusses aspects that have stood out in monitoring the service systems of Argentina, Brazil, Colombia, Spain, Paraguay, Peru, and Portugal throughout the 21st century’s first decade. Forty-five indicators and time series showing the highest completeness degree divided into social determinants, conditions and performance were analyzed. Three trends are common to almost all countries: overweight increase, negative trade balance for pharmaceutical products, and an increase in health system expenditure. This convergence trend reveals the need for changes in the way of regulating, organizing and delivering health services with public policies and practices that guarantee comprehensive care, including health promotion actions enabling systems sustainability.

Health systems; Information technology; Latin America; Spain; Portugal

Themes	Dimensions	Sub-dimensions	Indicators	Period Covered	Source
Social Determinants	Demographic	Dependency Ratio	Population total dependency ratio	2000-2011	World Bank
	Socio-economic	Income	% population below poverty line	2004-2010	World Bank
		Income	GDP per capita (dollars at current prices)	2000-2013	WolrdBank – OECD.
		Work	% of informality	2000-2012	CEPAL
		Work	Unemployment rate	2000-2013	CEPAL
		Inequality	GINI Index	2000-2010	World Bank
		Education	PISA: mathematical performance	2000, 2003, 2006, 2009	PISA-OECD
			PISA: reading performance	2000, 2003, 2006, 2009	PISA-OECD
			PISA: sciences performance	2000, 2003, 2006, 2009	PISA-OECD
	Living Conditions	Nutrition	% population aged 15 years and older overweighed	2002, 2005, 2010	WHO
		Sanitary Facilities	% of population with access to adequate sanitation facilities	2000-2012	WHO
			% of urban population with access to adequate sanitation facilities	2000-2012	WHO
			% of rural population with access to adequate sanitation facilities	2000-2012	WHO
		Water	% of population with access to adequate water supply	2000-2012	WHO
			% of urban population with access to adequate water supply	2000-2012	WHO
			% of rural population with access to adequate water supply	2000-2012	WHO
		Violence and Mental Health	Death rate for homicide	2000-2011	Eurostat – PAHO
		Violence and Mental Health	Death rate for suicide	2000-2010	WHO
Conditions	Productive Complex	Development and Innovation	Gross domestic expenditure on research and development (R&D)in health (millions of dollars – PPP)	2005-2011	OECD
			Health expenditure on R&D as percentage of gross domestic expenditure on R&D	2005-2011	OECD
			Private gross expenditure on R&D in health	2005-2011	OECD
			Public gross expenditure on R&D in health	2005-2011	OECD
			Total number of technological medical patents per applicant country	2000-2012	WIPO
			Total number of pharmaceutical patents per applicant country	2000-2012	WIPO
		Trade Balance	Trade balance in pharmaceutical products in millions of dollars	2008-2012	WTO
	Financing	Sectorial Expenditure	Health expenditure as percentage of gross domestic product (GDP %)	2000-2012	WHO
		Sectorial Expenditure	Public health expenditure as percentage of total public expenditure	2000-2012	WHO
		Public/Private Composition	Private health expenditure as percentage of total health expenditure	2000-2012	WHO
			Out of pocket expenditure as percentage of private health expenditure	2000-2012	WHO
			Private insurance expenditure as percentage of private health expenditure	2000-2012	WHO
			Public health expenditure as percentage of total total health expenditure	2000-2012	WHO
Performance	Effectiveness	Primare Care Avoidable Mortality	Infant mortality rate	2000-2012	Millenium Indicators
			Under-five mortality rate	2000-2012	Millenium Indicators
			Maternal mortality rate	2000, 2005 and 2010	Millenium Indicators
			Proportional mortality for acute diarrheal diseases in under-five	2000-2010	World Health Organization
			Proportional mortality for acute respiratory diseases in under-five	2000-2010	World Health Organization
			Mortality rate for ischemic heart diseases	2000-2010	Eurostat - PAHO
			Mortality rate for cerebrovascular diseases	2000-2010	Eurostat - PAHO
			Mortality rate for diabetes mellitus	2000-2010	Eurostat - PAHO
			Neonatal mortality rate	2000-2011	Eurostat - PAHO
			Post-neonatal mortality rate	2000-2011	Eurostat - PAHO
		Avoidable Morbidity	% of children with low birth weight	2000-2011	PAHO – OECD
			AIDS incidence rate in population aged 15 to 49 years old	2000-2012	Eurostat - PAHO
			Follow-up rate for TB cases treatment	2007-2011	WHO
		Programs Markers	% success in Directly Observed Treatment of TB cases with positive sputum baciloscopy .	2000-2011	WHO

Indicators- Social Determinants	Argentina			Brazil			Colombia			Spain			Paraguay			Peru			Portugal
	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%
Dependency ratio	61.3	53.8	-12.1	53.8	47.1	-14.4	61.3	51.5	-15.9	47.1	47.1	0	75.4	61.3	-18.8	63.9	56.3	-12	47.1	49.3	4.7
% population below poverty line	3.1	0.9	-71	8.5	5.4	-36.5	15.8	6.8	-57	**	**		6.7	5.7	-14.9	6.1	4.1	-32.8	**	**
GDP per capita (dollars at current prices)	9,329	14,715	57.7	3,694	11,208	203.4	2,503	7,825	212.6	14,413	29,117	102	1,531	4,402	187.5	1,949	6,659	241.7	11,399	21,035	84.5
% of informality	43	37.7	-12.3	45.6	37.3	-18.2	58.6	58.9	0.5	**	**		59.5	53.3	-10.4	63	57.1	-9.4	**	**
Unemployment rate	15.1	7.1	-53	7.1	5.4	-23.9	17.3	10.6	-38.7	11.9	26	118.5	10	8.1	-19	7.8	5.9	-24.4	4.5	16	255.6
Gini index	51.1	44.5	-12.9	60.1	54.7	-9	58.7	55.9	-4.8	32	33.9	5.9	56.2	52.4	-6.8	50.8	52.4	3.1	36	35	-2.8
PISA: average performance in a Math scale	388	388	0	334	391	17.1	370	376	1.6	476	484	1.7	**	**		292	368	26	454	487	7.3
PISA: average performance in reading scale	418	396	-5.3	396	410	3.5	385	403	4.7	493	488	-1	**	**		327	384	17.4	470	488	3.8
PISA: average performance in sciences scale	396	406	2.5	375	405	8	388	399	2.8	491	496	1	**	**		333	373	12	459	489	6.5
% population aged 15 years and older over weighted	66.1	74.5	12.7	46.3	57.1	23.3	53.9	61.9	14.8	50.7	53.8	6.1	46.2	50.3	8.9	56.7	65.5	15.5	51.5	56	8.7
% of population with access to adequate sanitation facilities	91.7	97.2	6	74.6	81.3	9	74.6	80.2	7.5	100	100	0	58.5	79.7	36.2	63.2	73.1	15.7	97.7	100	2.4
% of urban population with access to adequate sanitation facilities	92.8	97.1	4.6	82.8	87	5.1	83.3	84.9	1.9	100	100	0	79	96.1	21.6	75.8	81.2	7.1	99.1	100	0.9
% of rural population with access to adequate sanitation facilities	82.5	99.4	20.5	39.5	49.2	24.6	52.2	65.7	25.9	100	100	0	33.1	52.5	58.6	28.9	44.8	55	96	100	4.2
% of population with access to adequate water supply	96.5	98.7	2.3	93.5	97.5	4.3	89.9	91.2	1.4	100	100	0	73.5	93.8	27.6	80.6	86.8	7.7	97.9	99.8	1.9
% of urban population with access to adequate water supply	98.1	99	0.9	97.6	99.7	2.2	97.2	96.9	-0.3	99.9	99.9	0	91.4	100	9.4	89.6	91.2	1.8	98.7	99.8	1.1
% of rural population with access to adequate water supply	81.1	95.3	17.5	75.7	85.3	12.7	71	73.6	3.7	100	100	0	51.2	83.4	62.9	56.4	71.6	27	97	99.9	3
Death rate for homicide	5.9	4.3	-27.1	31.3	26	-16.9	78.1	53.1	-32	1	0.7	-30	23.8	12.7	-46.6	**	**		0.9	1.2	33.3
Death rate for suicide	7.5	7.5	0	4.2	4.8	14.3	6.2	5.1	-17.7	6.5	5.6	-13.8	3.4	3.9	14.7	**	**		3.7	7	89.2

Conditions - Indicators	Argentina			Brazil			Colombia			Spain			Paraguay			Peru			Portugal
	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%
Health gross domestic expenditure on ic research and development (R&D)(millions of dollars - PPP)	288	611	112.2	**	**		**	**		3,329	3,733	12.1	**	**		**	**		176	591.1	235.9
Health expenditure on R&D as percentage of gross domestic expenditure R&D	14.9	13	-12.8	**	**		**	**		18.2	18.6	2.2	**	**					10	14	40
Private gross expenditure on R&D	122	222	82	**	**		**	**		1,508	1,405	-6.8	**	**		**	**		54.4	184.9	239.9
Public t gross expenditure on R&D	85.6	168	96.3	**	**		**	**		713	1,495	109.7							**	**
Total number of technological medical patents per applicant country	53	26	-50.9	206	227	10.2	18	26	44.4	210	520	147.6	**	**		1	3	200	9	33	266.79
Total number of pharmaceutical patents per applicant country	32	27	-15.6	122	193	58.2	1	13	1200	237	1,097	362.9	**	**		**	**		41.5	129	210.8
Trade balance in pharmaceutical products in millions of dollars	-627	-1,302	107.7	-3,920	-6,043	54.2	-840	-1,756	109	-3,879	-2,164	-44.2	-75	-130	73.3	-437	-619	41.6	-2,399	-1,967	-18
Health expenditure as percentage of GDP	9.21	5.02	-45.5	7.03	8.26	17.5	5.91	6.93	17.3	7.21	9.39	30.24	8.1	10.3	27.5	4.83	5.18	7.2	9.14	9.74	6.6
Public health expenditure as percentage of total public expenditure	17.6	8.7	50.3	4.8	6.86	68.1	19.3	18.8	15.4	13.2	14.1	6.9	17.7	11.5	-35.3	14.1	13.9	-1.56	14.5	12.8	-11.4
Private health expenditure as percentage of total health expenditure	46.1	41.1	-11	59.7	55.7	-6.7	20.7	23.8	15.4	28.4	28.3	-0.4	60.1	55.5	-7.7	43.6	45	3.12	32.3	36	11.5
Out of pocket as percentage of private health expenditure	63	65.5	3.9	63.6	48.3	-24	59	60.9	3.2	83.1	79.7	-4	86.6	91.4	5.5	83.4	79.2	-5.1	70	76.2	8.8
Private insurance expenditure as percentage of private health expenditure	30.7	25.9	-15.4	34.3	49.4	44	41	39.1	-4.6	13.7	29.3	50.4	13.4	8.6	-35.6	12.8	10.3	-19.9	10.2	14.4	41.8
Public health expenditure as percentage of total health expenditure	53.9	59	9.4	40.3	44.3	10	79.3	76.1	-4.6	71.6	71.7	0.2	39.9	44.5	11.6	56.4	55	-2.4	67.8	64	-5.5

Indicators- Performance	Argentina			Brazil			Colombia			Spain			Paraguay			Peru			Portugal
Indicators- Performance	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%	Start	End	%
Infant Mortality rate	18	12.7	-29.4	29.1	12.9	-55.7	21.3	15.1	-29.1	5.4	3.8	-29.6	27.1	18.8	-30.6	30.4	14.1	-53.6	5.7	2.9	-49.1
Under-five mortality rate	20.2	14.2	-29.7	33.1	14.4	-56.5	25.2	17.6	-30.2	6.5	4.5	-30.8	32.7	22	-32.7	39.7	18.2	-54.2	7.4	3.6	-51.4
Maternal mortality rate	63	76	20.6	85	68	-20	130	85	-34.6	5	6	20	120	110	-8.3	160	100	-37.5	11	11	0
Proportional mortality for acute diarrhea in under-five	2	2	0	9	3	-66.7	5	4	-20	1	1	0	8	5	-37.5	5	4	-20	**	**	**
Proportional mortality for acute respiratory diseases in under-five	7	10	42.9	12	7	-41.7	11	10	-9.1	2	3	50	14	11	-21.4	11	10	-9.1	4	4	0
Mortality rate for ischemic heart diseases	57.3	48	-16.2	58.6	59.5	1.5	66.6	75.3	13.1	126.5	85.8	-32.2	36.9	50	35.5	21.9	22.8	4.1	119.3	79.6	-33.3
Mortality rate for cerebrovascular diseases	60.8	47.1	-22.5	63.3	59.1	-6.6	41.8	35.5	-15.1	124.2	74.6	-39.9	55.5	49.6	-10.6	24.3	22.5	-7.4	297.2	153.4	-48.4
Mortality rate for diabetes mellitus	24.1	19.9	-17.4	26.3	32.6	24	19.7	18.1	-8.1	30.5	24	-21.3	29	37.6	29.7	11.6	14	20.7	42.1	47	11.6
Neonatal mortality rate	10.9	7.6	-30.3	17.5	10.7	-38.9	-	-	-	2.8	2.1	-25	11	11	0	13	8	-38.5	3.4	2.4	-29.4
Post-neonatal mortality rate	5.7	4.1	-28.1	9.9	4.6	-53.5	-	-	-	3.6	3.2	-11.1	9.2	4.5	-51.1	9	8	-11.1	3.7	2.3	-37.8
% of children with low birth weight	8	7.2	-10	8.1	8.5	4.9	7.6	9	18.4	6.5	7.8	20	6	6.3	5	8.4	6.9	-17.9	**	**	**
AIDS incidence rate in 15- 49 years old	6.6	3	-54.5	17.4	19.7	13.2	1.3	3.1	138.5	26	26	0	1.2	5.1	325	4.4	3.3	-25	10.3	3.3	-68
Follow-up rate for TB cases treatment	31	25	-19.4	48	46	-4.2	37	33	-10.8	19	14	-26.3	48	45	-6.3	126	95	-24.6	32	26	-18.8
Success proportion in Directly Observed Treatment (DOT) of TB cases with positive baciloscopy	47	52	10.6	71	76	7	80	77	-3.8	70	73	4.3	66	78	18.2	90	74	-17.8	79	80	1.3

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[1] Collaborations

EM Conill coordinated the research, the text writing and review, DR Xavier participated in research, analysis, and text writing and review, SF Piola in the analysis and review, SF Silva, HS Barros and E Báscolo in research and review.