Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness
Abstract
:1. Introduction
2. Method
- –
- it is the dependent variable (DV) where i = unit and t = time;
- –
- k,it represents the independent variables (IV);
- –
- βk is the IV coefficient;
- –
- μit is the error term;
- –
- εn is the n unit;
- –
- γ2 is the unit coefficient;
- –
- Tt is the time;
- –
- δt is the time-related coefficient.
3. Results
3.1. The Statistical Models: The Effects on Health Levels
3.2. A First Glance at the Health Impacts Derived from the Models
3.3. Putting It All Together: Further Views and Synthesis
4. Discussion
4.1. The Models and Techniques: What Do They Tell Us?
4.2. Examples of Economic Development Models in Sao Paulo
4.3. The Typologies: On How Social Inequity and Vulnerability Interplay in the Context of Capitalism
5. Study Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
FE | Fixed Effects |
DEA | Data Envelopment Analysis |
LEB | life expectancy at birth |
IM | infant mortality |
RRAS | regionalized healthcare networks |
HR | health regions |
HDI | Human Development Index |
IPVS | Sao Paulo Social Vulnerability Index |
IPRS | Sao Paulo Social Responsibility Index |
MPF | Federal Prosecution Ministry |
MW | minimum wage |
PHC | Primary Health Care |
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Dimension/Variable | Variables | Data Source |
---|---|---|
Physical/financial resources | Per capita health expenditures derived from local tax revenues * % GDP destined to the service sector * % of health local revenues * Nurse density Per capita GDP % population receiving < ¼ MW % IPVS6 very high vulnerability Average per capita income | SES/SP SES/SP SES/SP CNES/DATASUS IBGE IBGE SEADE IBGE |
Health production | % of hospital admissions sensitive to primary care * % overall vaccination coverage * Stroke hospitalization rate * % PHC coverage * % breast cancer screening % cervical cancer screening % newborns whose mothers had at least seven prenatal consultations Overall proportion of Caesarean sections | SIA/SIH PNI CIH SIAB SISMAMA SISCOLO SINASC SINASC (DATASUS) |
Environmental/intersectoral | % vulnerable population dependent on the elderly * Income-ethnicity ratio (white/black and brown populations) % population without electricity access Theil index % of adolescent mothers % of water supply Aging rate Illiteracy rate Ratio of % of high level of education by gender and ethnicity (white men/black and brown women) Unemployment rate | IBGE IBGE IBGE PNUD IBGE IBGE IBGE IBGE IBGE IBGE |
Dimension/Variable | LEB | IM |
---|---|---|
Physical and Financial Resources | % population receiving < ¼ MW (-) % IPVS6 very high vulnerability (-) Average per capita income (R2 = 71.22%; p < 0.0001) | % population receiving < ¼ MW % IPVS6 very high vulnerability Average per capita income (-) Per capita GDP (-) Nurse density (R2 = 71.35%; p < 0.0001) |
Health Production | % Breast cancer screening (-) % Cervical cancer screening % newborns whose mothers had at least seven prenatal consultations (-) Overall proportion of Caesarean sections (R2 = 5.17%; p < 0.0001) | % Breast cancer screening % Cervical cancer screening (-) % newborns whose mothers had at least seven prenatal consultations Overall proportion of Caesarean sections (-) (R2 = 5.06%; p < 0.0001) |
Environment/intersectoral | Theil Index (-) % adolescent mothers (-) % Water supply Aging rate Illiteracy rate (-) Ratio of % high level of education, gender and ethnicity (-) Unemployment rate (-) (R2 = 79.96%; p < 0.0001) | Theil index % children out of school % population without electricity access Aging rate (-) Ethnicity-income ratio (-) Ratio of % high level of education, gender and ethnicity Unemployment rate (R2 = 82.03%; p < 0.0001) |
Overall—all dimensions | % population receiving < ¼ MW (-) % IPVS6 very high vulnerability (-) Average per capita income Theil Index (-) % adolescent mothers (-) Aging rate Illiteracy rate (-) Unemployment rate (-) % Water supply (R2 = 81.06%; p < 0.0001) | % population receiving < ¼ MW %IPVS6 very high vulnerability Ethnicity-income ratio (-) Theil Work Index % of children (0–5 years) out of school Aging rate (-) Illiteracy rate Unemployment rate (R2 = 81.87%; p < 0.0001) |
RRAS | Name | Health Levels | Efficiency | Efficiency | Efficiency | Equity | Vulnerability | Education | Opportunities | Living Conditions |
---|---|---|---|---|---|---|---|---|---|---|
Results | Synthesis | Fixed Effects | DEA | Variables | Variables | Variables | Variables | Variables | ||
1 | GSP—ABC | high | medium-high | medium-high | high | medium (I) | medium-high | high | low | high |
2 | GSP—Alto Tietê | low | Medium | high | medium-low | medium-high (I) | medium-high | medium-low | low | medium |
3 | GSP—Franco da Rocha | medium | medium-high | high | medium | High (I) | high | medium-high | low | medium |
4 | GSP—Mananciais | medium | medium-high | high | medium-high | medium-high (I) | high | medium | low | medium |
5 | GSP—Rota dos Bandeirantes | high | medium-high | medium-high | medium-high | medium-high (IIe) | medium-high | medium-high | low | high |
6 | GSP—SP | high | medium-low | low | medium | Low (IIwIeE) | medium-high | high | medium | high |
7 | Registro and Santos | medium-low | Medium | medium-high | medium-low | medium-low (I) | medium-high | medium-low | medium | low |
8 | Sorocaba | low | medium-low | medium | low | medium (Iw) | medium-high | low | medium | low |
9 | Bauru | medium | medium-low | low | medium-low | medium-high (E) | medium | medium-low | high | medium |
10 | Marília | low | medium-low | low | medium | Medium (E) | medium-low | medium | high | medium-low |
11 | Presidente Prudente | low | medium-high | medium | medium-high | medium-low (Iw) | medium-low | medium-low | medium-high | low |
12 | Araçatuba and SJ Rio Preto | medium-low | medium-low | low | medium | medium-high (E) | low | medium-low | high | medium-low |
13 | Ribeirão Preto, Araraquara, Barretos, and Franca | medium | medium-low | low | medium-low | Medium (EIe) | medium-low | medium-low | medium | medium-high |
14 | Piracicaba | high | Medium | medium | medium | medium-low (EIe) | medium-low | medium-high | medium | high |
15 | Campinas and S João Boa Vista | high | medium-high | medium | high | medium-low (EIe) | low | medium-high | high | medium-high |
16 | Campinas | medium | medium-low | medium | medium-low | medium-high (E) | medium-low | medium | medium-high | medium-low |
17 | Taubaté | medium | medium-high | medium-high | medium | medium-low (I) | medium-low | medium-high | medium | medium-low |
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Schenkman, S.; Bousquat, A.; Ferreira, M.P. Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness. Int. J. Environ. Res. Public Health 2022, 19, 2990. https://doi.org/10.3390/ijerph19052990
Schenkman S, Bousquat A, Ferreira MP. Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness. International Journal of Environmental Research and Public Health. 2022; 19(5):2990. https://doi.org/10.3390/ijerph19052990
Chicago/Turabian StyleSchenkman, Simone, Aylene Bousquat, and Maria Paula Ferreira. 2022. "Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness" International Journal of Environmental Research and Public Health 19, no. 5: 2990. https://doi.org/10.3390/ijerph19052990