Rodrigo da Silva Moreira

Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise

This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.

Uma analise da utilização de serviços de saúde por sistema de financiamento: Brasil 1998 -2008

This article analyzes the use of health services from the perspective of financing based on PNAD/IBGE micro-data related to 1998, 2003 and 2008. Among the main results, the following can be highlighted: 1) The Unified Health System (SUS) continues to be the major financing agent of most consultations and hospitalizations in Brazil; its participation increased significantly between 1998 and 2003 and remained almost stable between 2003 and 2008; 2) SUS participation in financing the use of the health services has been predominant in all Brazilian regions, especially in the North and North-East, which feature the most precarious socio-economic and health conditions; 3) SUS is the major financing agent of the two extreme levels of complexity of health care: primary care and high complexity services. 4) In spite of a significant rise in utilization rates of SUS services for consultations and hospitalizations, great inequities can still be observed between the population that exclusively uses SUS and that which has private health insurance; 5) There has been an increase in the use of SUS health services by part of the population with private health insurance plans.

Estimativas da cobertura de mamografia segundo inquéritos de saúde no Brasil

OBJECTIVE Population surveys constitute an essential tool to monitor mammography coverage and factors associated with its performance. Estimates tend to be overestimated in surveys based on the population living in households with a telephone. The study aimed to estimate mammography coverage from population-based surveys. METHODS Based on mammography coverage levels in women aged between 50 and 69 years, with and without a fixed telephone line, from the Pesquisa Nacional por Amostra de Domicílios 2003 (PNAD--2003 National Household Survey), ratios between these coverage levels and their respective variation coefficient were calculated. The coverage ratio was multiplied by the coverage estimated by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), enabling coverage in women without telephones in 2007 to be estimated. These estimates were applied to the female population, with and without a telephone, obtained from the PNAD 2006, thus achieving the final estimates for the capitals. RESULTS In 2007, mammography coverage was estimated at about 70% for the group of capitals, varying from 41.2% in Porto Velho (Northern Brazil) to 82.2% in Florianópolis (Southern Brazil). In 17 cities, coverage was higher than 60%; in eight, between 50% and 60%; and in two, below 50%. In absolute terms, the difference between VIGITEL coverage levels and those estimated was 6.5%, varying from 3.4% in São Paulo (Southeastern Brazil) to 24.2% in João Pessoa (Northeastern Brazil). CONCLUSIONS Differences in magnitudes of mammography coverage estimates for population surveys are mostly a reflection of study designs. In the specific case of mammography, it would be more appropriate to estimate its coverage by combining VIGITEL data with those from other surveys that include information about women with and without a fixed telephone line, especially in cities with low fixed telephone line coverage.OBJETIVO: Inqueritos populacionais constituem ferramenta fundamental para monitorar a cobertura de mamografia e os fatores associados a sua realizacao. Em inqueritos baseados na populacao residente em domicilios com telefone as estimativas tendem a ser superestimadas. O estudo teve por objetivo estimar a cobertura de mamografia com base em pesquisas de base populacional. METODOS: A partir das coberturas por mamografia em mulheres de 50 a 69 anos, com e sem telefone fixo, observadas na Pesquisa Nacional por Amostra de Domicilios (PNAD) 2003, calcularam-se as razoes entre elas e o respectivo coeficiente de variacao. A razao de cobertura foi multiplicada pela cobertura estimada pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), permitindo estimar a cobertura entre mulheres sem telefone em 2007. Essas estimativas foram aplicadas a populacao de mulheres, com e sem telefone, obtidas a partir da PNAD 2006, obtendo-se assim as estimativas finais para as capitais. RESULTADOS: Em 2007, para o conjunto das capitais, estimou-se a cobertura de mamografia em aproximadamente 70%, variando de 41,2% em Porto Velho (RO) a 82,2% em Florianopolis (SC). Em 17 municipios a cobertura foi maior que 60%; em oito, de 50%-60%; e em dois, a cobertura foi inferior a 50%. Em termos absolutos, a diferenca entre as coberturas do VIGITEL e as estimadas foi de 6,5% para o conjunto dos municipios, variando de 3,4% em Sao Paulo (SP) a 24,2% em Joao Pessoa (PB). CONCLUSOES: As diferencas nas magnitudes das estimativas da cobertura de mamografia por inqueritos populacionais sao em grande parte reflexo dos desenhos dos estudos. No caso especifico da mamografia, seria mais apropriado estimar sua cobertura combinando dados do VIGITEL com aqueles de outros inqueritos, que incluam informacoes sobre mulheres com e sem telefone fixo, especialmente em municipios de baixa cobertura de telefonia fixa.

Regionalização e desenvolvimento humano: uma proposta de tipologia de Regiões de Saúde no Brasil

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).

Diferenças regionais no acesso a cirurgia cardiovascular no Brasil, 2002 -2010

The hospitalization rates for angioplasty and coronary bypass surgery have been used as proxies for access to highly specialized services. The scope of this study is to analyze the evolution of these rates and discuss what are the possible causes associated with regional inequalities. Standardized rates of angioplasty and coronary bypass surgery by age and sex per 100,000 inhabitants aged 20 and over, in the period from 2002 to 2010 were calculated. Comparison with international data shows that Brazil has lower rates than those observed in OECD countries. In Brazil, the standardized rates of hospitalization for angioplasty in the population aged 20 and over showed an upward trend, rising from 27.5 per 100,000 in 2002 to 39 in 2010. When mortality rates by age and sex from different geographical regions were compared, besides the marked differences in the north - south axis, what is notable is the maintenance of a stable pattern of these rates and regional differences over the period analyzed. The definition of regional health care networks for cardiac surgery is an important strategy to ensure the quality of care, optimization of operating costs and reduction of inequalities in access to healthcare between Brazilian regions.

Estimates of mammography coverage according to health surveys in Brazil

OBJECTIVE Population surveys constitute an essential tool to monitor mammography coverage and factors associated with its performance. Estimates tend to be overestimated in surveys based on the population living in households with a telephone. The study aimed to estimate mammography coverage from population-based surveys. METHODS Based on mammography coverage levels in women aged between 50 and 69 years, with and without a fixed telephone line, from the Pesquisa Nacional por Amostra de Domicílios 2003 (PNAD--2003 National Household Survey), ratios between these coverage levels and their respective variation coefficient were calculated. The coverage ratio was multiplied by the coverage estimated by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), enabling coverage in women without telephones in 2007 to be estimated. These estimates were applied to the female population, with and without a telephone, obtained from the PNAD 2006, thus achieving the final estimates for the capitals. RESULTS In 2007, mammography coverage was estimated at about 70% for the group of capitals, varying from 41.2% in Porto Velho (Northern Brazil) to 82.2% in Florianópolis (Southern Brazil). In 17 cities, coverage was higher than 60%; in eight, between 50% and 60%; and in two, below 50%. In absolute terms, the difference between VIGITEL coverage levels and those estimated was 6.5%, varying from 3.4% in São Paulo (Southeastern Brazil) to 24.2% in João Pessoa (Northeastern Brazil). CONCLUSIONS Differences in magnitudes of mammography coverage estimates for population surveys are mostly a reflection of study designs. In the specific case of mammography, it would be more appropriate to estimate its coverage by combining VIGITEL data with those from other surveys that include information about women with and without a fixed telephone line, especially in cities with low fixed telephone line coverage.OBJETIVO: Inqueritos populacionais constituem ferramenta fundamental para monitorar a cobertura de mamografia e os fatores associados a sua realizacao. Em inqueritos baseados na populacao residente em domicilios com telefone as estimativas tendem a ser superestimadas. O estudo teve por objetivo estimar a cobertura de mamografia com base em pesquisas de base populacional. METODOS: A partir das coberturas por mamografia em mulheres de 50 a 69 anos, com e sem telefone fixo, observadas na Pesquisa Nacional por Amostra de Domicilios (PNAD) 2003, calcularam-se as razoes entre elas e o respectivo coeficiente de variacao. A razao de cobertura foi multiplicada pela cobertura estimada pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), permitindo estimar a cobertura entre mulheres sem telefone em 2007. Essas estimativas foram aplicadas a populacao de mulheres, com e sem telefone, obtidas a partir da PNAD 2006, obtendo-se assim as estimativas finais para as capitais. RESULTADOS: Em 2007, para o conjunto das capitais, estimou-se a cobertura de mamografia em aproximadamente 70%, variando de 41,2% em Porto Velho (RO) a 82,2% em Florianopolis (SC). Em 17 municipios a cobertura foi maior que 60%; em oito, de 50%-60%; e em dois, a cobertura foi inferior a 50%. Em termos absolutos, a diferenca entre as coberturas do VIGITEL e as estimadas foi de 6,5% para o conjunto dos municipios, variando de 3,4% em Sao Paulo (SP) a 24,2% em Joao Pessoa (PB). CONCLUSOES: As diferencas nas magnitudes das estimativas da cobertura de mamografia por inqueritos populacionais sao em grande parte reflexo dos desenhos dos estudos. No caso especifico da mamografia, seria mais apropriado estimar sua cobertura combinando dados do VIGITEL com aqueles de outros inqueritos, que incluam informacoes sobre mulheres com e sem telefone fixo, especialmente em municipios de baixa cobertura de telefonia fixa.

Regionalization and human development: a typology of health regions in Brazil

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).

Regionalización y desarrollo humano: una clasificación para las regiones de salud brasileñas

This article aimed to present a proposal for characterizing health regions in Brazil based on human development, contributing to the identification of comparable geographic areas for observation, analysis, and monitoring of performance in regionalized health systems. The dimensions of the Municipal Human Development Index were calculated for the health regions by aggregating data from municipalities, weighted by population size. The grouping of health regions in 5 groups, based on combinations of life expectancy, income, and schooling, was determined by the K-Means method. Approximately half of Brazils health regions were classified as type 1 and the other half as types 3 to 5. The typology provides a clustering model for homogeneous health regions, consistent with the theoretical assumptions of PROADESS. The choice of well-established indicators and aggregation methods tends to facilitate their comprehension and use by the actors involved in the administration of the Brazilian Unified National Health System (SUS).O objetivo do trabalho foi apresentar uma proposta de diferenciacao das Regioes de Saude no Brasil, baseada no desenvolvimento humano, contribuindo para a identificacao de espacos geograficos comparaveis para observacao, analise e acompanhamento do desempenho dos sistemas regionalizados de saude. Os valores das dimensoes do Indice de Desenvolvimento Humano Municipal foram calculados para as Regioes de Saude pela agregacao dos dados dos municipios, ponderados pelo seu tamanho populacional. O agrupamento das Regioes de Saude em 5 grupos, segundo combinacoes de longevidade, riqueza e escolaridade, foi determinado pelo metodo K-Medias. Metade das Regioes de Saude brasileiras foi classificada em grupos do tipo 1 e 2 e a outra metade em grupos dos tipos 3 a 5. A tipologia apresentada oferece um modelo de agrupamento de Regioes de Saude homogeneas, coerente com os pressupostos teoricos do PROADESS. A opcao por indicadores e metodos de agregacao bem estabelecidos tende a favorecer a sua compreensao e utilizacao pelos atores ligados a gestao do Sistema Unico de Saude (SUS).

Estimaciones de la cobertura de mamografía según encuestas de salud en Brasil

OBJECTIVE Population surveys constitute an essential tool to monitor mammography coverage and factors associated with its performance. Estimates tend to be overestimated in surveys based on the population living in households with a telephone. The study aimed to estimate mammography coverage from population-based surveys. METHODS Based on mammography coverage levels in women aged between 50 and 69 years, with and without a fixed telephone line, from the Pesquisa Nacional por Amostra de Domicílios 2003 (PNAD--2003 National Household Survey), ratios between these coverage levels and their respective variation coefficient were calculated. The coverage ratio was multiplied by the coverage estimated by the Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases), enabling coverage in women without telephones in 2007 to be estimated. These estimates were applied to the female population, with and without a telephone, obtained from the PNAD 2006, thus achieving the final estimates for the capitals. RESULTS In 2007, mammography coverage was estimated at about 70% for the group of capitals, varying from 41.2% in Porto Velho (Northern Brazil) to 82.2% in Florianópolis (Southern Brazil). In 17 cities, coverage was higher than 60%; in eight, between 50% and 60%; and in two, below 50%. In absolute terms, the difference between VIGITEL coverage levels and those estimated was 6.5%, varying from 3.4% in São Paulo (Southeastern Brazil) to 24.2% in João Pessoa (Northeastern Brazil). CONCLUSIONS Differences in magnitudes of mammography coverage estimates for population surveys are mostly a reflection of study designs. In the specific case of mammography, it would be more appropriate to estimate its coverage by combining VIGITEL data with those from other surveys that include information about women with and without a fixed telephone line, especially in cities with low fixed telephone line coverage.OBJETIVO: Inqueritos populacionais constituem ferramenta fundamental para monitorar a cobertura de mamografia e os fatores associados a sua realizacao. Em inqueritos baseados na populacao residente em domicilios com telefone as estimativas tendem a ser superestimadas. O estudo teve por objetivo estimar a cobertura de mamografia com base em pesquisas de base populacional. METODOS: A partir das coberturas por mamografia em mulheres de 50 a 69 anos, com e sem telefone fixo, observadas na Pesquisa Nacional por Amostra de Domicilios (PNAD) 2003, calcularam-se as razoes entre elas e o respectivo coeficiente de variacao. A razao de cobertura foi multiplicada pela cobertura estimada pelo sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Inquerito Telefonico (VIGITEL), permitindo estimar a cobertura entre mulheres sem telefone em 2007. Essas estimativas foram aplicadas a populacao de mulheres, com e sem telefone, obtidas a partir da PNAD 2006, obtendo-se assim as estimativas finais para as capitais. RESULTADOS: Em 2007, para o conjunto das capitais, estimou-se a cobertura de mamografia em aproximadamente 70%, variando de 41,2% em Porto Velho (RO) a 82,2% em Florianopolis (SC). Em 17 municipios a cobertura foi maior que 60%; em oito, de 50%-60%; e em dois, a cobertura foi inferior a 50%. Em termos absolutos, a diferenca entre as coberturas do VIGITEL e as estimadas foi de 6,5% para o conjunto dos municipios, variando de 3,4% em Sao Paulo (SP) a 24,2% em Joao Pessoa (PB). CONCLUSOES: As diferencas nas magnitudes das estimativas da cobertura de mamografia por inqueritos populacionais sao em grande parte reflexo dos desenhos dos estudos. No caso especifico da mamografia, seria mais apropriado estimar sua cobertura combinando dados do VIGITEL com aqueles de outros inqueritos, que incluam informacoes sobre mulheres com e sem telefone fixo, especialmente em municipios de baixa cobertura de telefonia fixa.