Abstract
In the context of crisis and resource constraints, it is reasonable to assume the deteriorated weaknesses of the Unified Health System (SUS), such as regional inequalities, underfinancing, and care quality issues. This study explored the application of easily comprehensible and calculated access and effectiveness indicators that could reflect the hospital network crisis. Five indicators extracted from the Hospital Information System, related to Brazil and states of the Southeastern region, were analyzed in the 2009-2018 period: hospitalizations resulting in death; surgical hospitalizations resulting in death; elective surgeries in the total of surgical hospitalizations; hip prostheses in the senior population; and angioplasties in the population aged 20 years and over. Statistical control charts were used to compare indicators between states, before and from 2014. In Brazil, overall hospital deaths had a slight increase while surgical deaths declined; elective surgeries and hipprosthesis also decreased. In Southeastern Brazil, Rio de Janeiro was the worst performer, especially the decrease of the elective surgeries. The results illustrate the potential of indicators to monitor crisis effects on hospital care.
Highlights
Gross Domestic Product (GDP) had been evolving positively since 2002 in the Brazilian macroeconomic scenario of the 21st century, except for a few quarters of 2009 and 2014 to 20161
It is urgent to monitor the performance of the SUS, even as a strategy to avoid setbacks in the path taken. Considering this general situation and the importance of monitoring closely to contextual events, this study aimed to explore the application of understandable and calculated indicators that could reflect the crisis in the SUS hospital network
The results showed in charts show the behavior of the five indicators in two periods, from 2009 to 2013 and 2014 to 2018, in Brazil and the four states of the Southeast
Summary
Gross Domestic Product (GDP) had been evolving positively since 2002 in the Brazilian macroeconomic scenario of the 21st century, except for a few quarters of 2009 and 2014 to 20161. Between 2017 and 2018, efforts to reduce inequalities suffered visible setbacks, with deteriorating indicators evidencing a declining social progress in the country[5]. An OXFAM report highlights, for example, stagnation in the Gini index, general retraction of national income and rising unemployment from 6.8% in 2014 to 12.7% in 2017. This unfavorable economic scenario produced a fiscal and political crisis, and the emergence of a series of austerity measures[5,6]. By 2036, health may lose an amount of 400-700 billion reais, which is a risk to the Unified Health System (SUS)[7] that, besides being historically underfunded, must prospectively face population aging and epidemiological profile that combines chronic, infectious diseases and external causes
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