Background
Challenges facing the Brazilian health system
History of private sector participation in the SUS
Politics of the privatization debate
Political parties in Brazil
Methods
Model building process
Measures of private-sector healthcare administration
Key explanatory variables
Covariates
Results
Descriptive statistics
Year | Equipment | Outsourcing (% health expenditures) | Health Spending per capita (2012 $R) | |||
---|---|---|---|---|---|---|
Dental (% Private) | X-Rays (% Private) | Ultrasounds (% Private) | Hosp. Beds (% Private) | |||
2008 | 12.3 | 34.8 | 35.8 | 21.9 | 14.5 | 312.4 |
(19.4) | (68.4) | (72.7) | (36.6) | (12.9) | (155.4) | |
2012 | 17.5 | 35.4 | 34.7 | 18.4 | 16.4 | 540.0 |
(33.3) | (69.7) | (71.4) | (21.6) | (15.2) | (260.3) | |
Change | 5.2 | 0.6 | −1.1 | −3.5 | 1.9 | +227.6 |
Regression analysis
Party Elected In 2008 | Dental | X-rays | Ultrasounds | Hospital Beds | Outsourcing | Health Expenditures |
---|---|---|---|---|---|---|
DEM | −0.86 (0.55) | −0.40 (1.02) | 1.12 (1.27) | −0.11 (1.16) | −0.35 (0.46) | −.69 (1.19) |
PDT | 0.15 (0.66) | 0.40 (1.21) | 1.43 (1.50) | −0.20 (1.33) | −0.23 (0.54) | −2.84* (1.40) |
PMDB | −0.02 (0.39) | −0.30 (0.71) | 0.32 (0.88) | 0.50 (0.79) | −0.45 (0.33) | −0.07 (0.84) |
PP | 0.21 (0.54) | 0.34 (0.97) | −0.81 (1.24) | −1.57 (1.10) | −1.00* (0.45) | −0.48 (1.16) |
PPS | −0.16 (1.03) | 1.51 (1.84) | −0.72 (2.27) | 1.60 (2.10) | 0.58 (.84) | −0.29 (2.20) |
PR | 0.26 (0.62) | −1.28 (1.11) | −2.45. (1.38) | 0.90 (1.23) | 0.06 (0.52) | 1.73 (1.35) |
PSB | 0.024 (0.68) | 0.80 (1.31) | 0.49 (1.45) | 0.02 (1.30) | 0.55· (0.57) | 1.05 (1.47) |
PSDB | −0.25 (0.46) | −1.67* (0.81) | −2.12* (1.03) | −0.67 (0.96) | 0.21 (0.38) | 2.02* (0.99) |
PT | 0.40 (0.52) | 0.09 (0.92) | 3.51** (1.14) | 0.32 (1.01) | 1.21** (0.44) | 0.11 (1.13) |
PTB | 0.24 (0.60) | 0.51 (1.17) | −0.77 (1.40) | −0.78 (1.25) | −0.58 (0.51) | −0.52 (1.30) |
F statistic | 40.28 | 71.60 | 209.84* | 43.86 | 191.80* | 114.11 |
Num. obs. | 4650 | 3075 | 2429 | 2987 | 4347 | 4476 |
Dental | X-rays | Ultrasounds | Hospital Beds | Outsourcing | Health Expenditures | |
---|---|---|---|---|---|---|
Incumbency | 0.17 | −0.07 | 0.43 | −1.90*
| −0.46 | 0.75 |
(0.37) | (0.66) | (0.82) | (0.74) | (0.30) | (0.83) | |
HDI | 0.50***
| 0.44***
| 0.27*
| 0.11 | 0.21***
| 0.31*
|
(0.06) | (0.11) | (0.13) | (0.12) | (0.05) | (0.10) | |
Upper middle class income | 0.05***
| 0.04**
| 0.07**
| 0.05·
| −0.01 | 0.08**
|
(0.01) | (0.02) | (0.03) | (0.03) | (0.01) | (0.03) | |
Controls for Baseline and Aggregate Changeb
| ||||||
Total Equipment per capita end of term | 2.40***
| 4.29***
| 3.45***
| 0.35***
| ||
(0.08) | (0.28) | (0.50) | (0.05) | |||
Total Equipment per capita baseline | −2.91***
| −4.32***
| −3.38***
| −0.30***
| ||
(0.09) | (0.29) | (0.43) | (0.04) | |||
% Private Equipment baseline | 0.83***
| 0.79***
| 0.77***
| 0.75***
| ||
Interquartile Range | 0.19 | 0.68 | 0.72 | 0.37 | ||
(0.01) | (0.01) | (0.01) | (0.01) | |||
Outsourcing/Health Expenditures | 0.63***
| |||||
(0.01) | ||||||
Health Expenditures per capita | 0.77***
| |||||
(0.01) | ||||||
R2 Full Model | 0.76 | 0.76 | 0.73 | 0.67 | 0.44 | 0.69 |
R2 Political Variables Only | 0.01 | 0.01 | 0.02 | 0.01 | 0.01 | 0.01 |
Num. obs. | 4650 | 3075 | 2429 | 2987 | 4347 | 4476 |
Dental | X-rays | Ultrasounds | Hospital Beds | Outsourcing | Health Expenditures | |
---|---|---|---|---|---|---|
Party Elected In 2004 | ||||||
DEM | −0.78 | 1.81.
| 2.45.
| −0.35 | −0.41 | −0.94 |
(0.54) | (1.07) | (1.26) | (0.96) | (0.36) | (1.18) | |
PDT | −0.17 | −0.59 | −0.72 | 0.87 | 1.38** | 2.04 |
(0.69) | (1.43) | (1.82) | (1.34) | (0.53) | (1.72) | |
PMDB | −1.31** | −0.13 | 0.06 | 1.21 | 0.02 | 0.57 |
(0.44) | (0.90) | (1.17) | (0.83) | (0.32) | (1.04) | |
PP | −0.86 | −2.07.
| −2.40 | −3.14** | −0.38.
| 1.89 |
(0.56) | (1.16) | (1.48) | (1.09) | (0.41) | (1.34) | |
PPS | −0.24 | −0.39 | −1.03 | −1.62 | 1.06 | −1.48 |
(0.75) | (1.49) | (1.84) | (1.37) | (.56) | (1.84) | |
PR | 0.12 | 1.99 | 0.75 | 1.61 | −0.64 | −1.36 |
(0.71) | (1.42) | (1.69) | (1.28) | (0.49) | (1.60) | |
PSB | 1.06 | 0.50 | 1.90 | 2.08 | −0.21·
| −0.54 |
(1.19) | (2.31) | (2.52) | (1.73) | (0.70) | (2.31) | |
PSDB | 0.50 | −1.12 | −1.22 | 0.53 | −0.27 | −1.42 |
(0.48) | (1.00) | (1.18) | (0.91) | (0.35) | (1.13) | |
PT | 1.00.
| 2.01 | −0.13 | 0.16 | 0.39 | −1.71 |
(0.61) | (1.23) | (1.49) | (1.15) | (0.46) | (1.52) | |
PTB | 0.68 | −1.93 | 0.48 | −1.34 | −0.93* | 2.94.
|
(0.66) | (1.36) | (1.65) | (1.28) | (0.47) | (1.54) | |
F statistic | 201.65* | 151.47 | 93.81 | 176.11.
| 187.60.
| 125.74 |
Num. obs. | 3420 | 2840 | 1988 | 2998 | 4480 | 4534 |
Dental | X-rays | Ultrasounds | Hospital Beds | Outsourcing | Health Expenditures | |
---|---|---|---|---|---|---|
Incumbency | −0.27 | −0.35 | 0.85 | −0.85 | −0.46 | 0.02.
|
(0.42) | (0.86) | (1.10) | (0.01) | (0.00) | (0.01) | |
HDI | 0.19**
| 0.23.
| 0.62***
| −0.07 | 0.16***
| 0.79***
|
(0.06) | (0.13) | (0.15) | (0.12) | (0.04) | (0.14) | |
Upper middle class income | 0.09***
| 0.08**
| 0.06.
| 0.06*
| 0.04***
| −0.16***
|
(0.01) | (0.03) | (0.04) | (0.03) | (0.01) | (0.04) | |
Controls for Baseline and Aggregate Changec
| ||||||
Total Equipment per capita end of term | 0.92***
| 4.89***
| 8.85***
| 0.13***
| ||
(0.11) | (0.30) | (0.87) | (0.03) | |||
Total Equipment per capita baseline | −0.78***
| −4.73***
| −10.37***
| −0.07*
| ||
(0.11) | (0.29) | (0.85) | (0.03) | |||
% Private Equipment | 0.78***
| 0.77***
| 0.72***
| 0.80***
| ||
Interquartile Range | 0.20 | 0.67 | 0.73 | 0.47 | ||
(0.01) | (0.01) | (0.01) | (0.01) | |||
Outsourcing/Health Expenditures | 0.44***
| |||||
(0.01) | ||||||
Health Expenditures per capita | 0.70***
| |||||
(0.01) | ||||||
R2 Full model | 0.77 | 0.70 | 0.70 | 0.71 | 0.47 | 0.60 |
R2 Political variables only | 0.02 | 0.01 | 0.01 | 0.01 | 0.03 | 0.01 |
Num. obs. | 3420 | 2840 | 1988 | 2998 | 4480 | 4534 |
Discussion
Study limitations
Conclusions
Acknowledgements
Funding
Availability of data and materials
-
Cadastro Nacional de Estabelecimentos de Saúde (CNES), or National Registry of Health Establishments, maintained by the Brazilian Ministry of Health. http://datasus.saude.gov.br/
-
Sistema de Informações Sobre Orçamentos Públicos em Saúde (SIOPS), or Information System on Public Health Budgets database, provided by the Ministry of Health. http://siops.datasus.gov.br
-
Tribunal Superior Eleitoral (TSE), the Supreme Electoral Court, a public official database on local and national elections in Brazil. Accessible through: http://www.ipea.gov.br/portal/
-
2010 Brazilian Census. http://censo2010.ibge.gov.br/