Abstract
In the early 1990s, a group of British researchers developed a new methodology for healthcare resource allocation based on need. The methodology's main characteristics are to draw on the theoretical model for healthcare services demand and apply data on health services utilization to estimate needs-based use. The objective of the current study was to assess the applicability of this methodology for allocating Federal resources at the local level in Brazil. Data from all acute hospital admissions in 1999 came from the Inpatient Information System of the Unified National Health System (SUS). The country was divided into 134 geographic areas. The statistical models tested to estimate needs-based use applied the following need variables: infant mortality rate; standardized mortality rate; illiteracy rate; proportion of households headed by women; and mean number of household members. All tested models showed negative regression coefficients, indicating that the methodology is inadequate for resource allocation based on need in places like Brazil with large social inequalities in healthcare utilization.
Highlights
Diversos países têm realizado esforços para definir metodologias voltadas para orientar, de forma eqüitativa, a distribuição geográfica de recursos destinados ao financiamento do setor saúde
In the early 1990s, a group of British researchers developed a new methodology for healthcare resource allocation based on need
All tested models showed negative regression coefficients, indicating that the methodology is inadequate for resource allocation based on need in places like Brazil with large social inequalities in healthcare utilization
Summary
De acordo com o modelo teórico de demanda aos serviços de saúde, o uso de serviços é função das necessidades de saúde e da oferta de serviços. Tanto no modelo de uso como no de predição da demanda, o coeficiente geral de mortalidade padronizado por idade e sexo apresenta significância estatística e sinal positivo, indicando, como esperado, aumento das internações nas áreas de maior mortalidade geral. O objetivo foi excluir da modelagem as áreas com grande heterogeneidade nas características da população, que foram construídas a partir da agregação dos municípios com menos de 200 mil habitantes em cada Estado, independentemente de sua localização geográfica. O teste de endogeneidade foi estatisticamente significativo e os preditores do uso foram o percentual de analfabetos e a média de pessoas por domicílio, ambos com sinal negativo.
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