Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author MASSENBURG, Benjamin B.
SALUJA, Saurabh
JENNY, Hillary E.
RAYKAR, Nakul P.
NG-KAMSTRA, Josh
GUILLOUX, Aline G. A.
SCHEFFER, Mario C. FMUSP-HC
MEARA, John G.
ALONSO, Nivaldo FMUSP-HC
SHRIME, Mark G.
dc.date.issued 2017
dc.identifier.citation BMJ GLOBAL HEALTH, v.2, n.2, article ID UNSP e000226, 9p, 2017
dc.identifier.issn 2059-7908
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/21990
dc.description.abstract Background: Brazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves. Methods: Using Brazil's national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a. distribution of incomes based on Gini and gross domestic product/capita. Findings: In 2014, SAO density was 34.7/100 000 population, surgical volume was 4433 procedures/100 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators. Interpretation: Brazil's public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.
dc.description.sponsorship · GE Foundation Safe Surgery 2020 Project
· Steven C. and Carmella Kletjian Foundation
dc.language.iso eng
dc.publisher BMJ PUBLISHING GROUP
dc.relation.ispartof BMJ Global Health
dc.rights restrictedAccess
dc.subject.other health; expenditure; surgery
dc.title Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study
dc.type article
dc.rights.holder Copyright BMJ PUBLISHING GROUP
dc.description.group LIM/04
dc.description.group LIM/39
dc.identifier.doi 10.1136/bmjgh-2016-000226
dc.identifier.pmid 28589025
dc.type.category original article
dc.type.version publishedVersion
hcfmusp.author SCHEFFER, Mario C.:FM:MPR
hcfmusp.author ALONSO, Nivaldo:FM:MCG
hcfmusp.author.external · MASSENBURG, Benjamin B.:Icahn Sch Med Mt Sinai, Dept Med Educ, New York, NY 10029 USA; Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA
· SALUJA, Saurabh:Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA; Weill Cornell Med, Dept Surg, New York, NY USA
· JENNY, Hillary E.:Icahn Sch Med Mt Sinai, Dept Med Educ, New York, NY 10029 USA; Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA
· RAYKAR, Nakul P.:Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA; Beth Israel Deaconess Med Ctr, Dept Surg, 330 Brookline Ave, Boston, MA 02215 USA
· NG-KAMSTRA, Josh:Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA; Univ Toronto, Dept Surg, Toronto, ON, Canada
· GUILLOUX, Aline G. A.:Univ Sao Paulo, Fac Med, Dept Med Prevent, Sao Paulo, Brazil
· MEARA, John G.:Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Boston Childrens Hosp, Dept Plast & Oral Surg, Boston, MA USA
· SHRIME, Mark G.:Harvard Med Sch, Program Global Surg & Social Change, Boston, MA 02115 USA; Massachusetts Eye & Ear, Dept Otolaryngol, Boston, MA 02114 USA
hcfmusp.origem.id WOS:000408746500044
hcfmusp.publisher.city LONDON
hcfmusp.publisher.country ENGLAND
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dc.description.index PubMed
hcfmusp.citation.wos 9
hcfmusp.affiliation.country Brasil
hcfmusp.affiliation.country Estados Unidos
hcfmusp.affiliation.country Canadá


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