MARIO CESAR SCHEFFER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study(2017) MASSENBURG, Benjamin B.; SALUJA, Saurabh; JENNY, Hillary E.; RAYKAR, Nakul P.; NG-KAMSTRA, Josh; GUILLOUX, Aline G. A.; SCHEFFER, Mario C.; MEARA, John G.; ALONSO, Nivaldo; SHRIME, Mark G.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.
- The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil(2020) ANDRIETTA, Lucas Salvador; LEVI, Maria Luiza; SCHEFFER, Mario C.; ALVES, Maria Teresa Seabra Soares de Britto e; OLIVEIRA, Bruno Luciano Carneiro Alves de; RUSSO, GiulianoIntroduction Although economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhao and Sao Paulo, two unevenly developed states in Brazil, to explore the health financing and system performance changes brought in by its 2014-2015 economic recession. Methods Drawing from economic and health system research literature, we designed a conceptual framework exploring the links between macroeconomic factors, labour markets, demand and supply of health services and system performance. We used data from the National Health Accounts and National Household Sample Survey to examine changes in Brazil's health spending over the 2010-2018 period. Data from the National Agency of Supplementary Health database and the public health budget information system were employed to compare and contrast health financing and system performance of Sao Paulo and Maranhao. Results Our analysis shows that Brazil's macroeconomic conditions deteriorated across the board after 2015-2016, with Sao Paulo's economy experiencing a wider setback than Maranhao's. We showed how public health expenditures flattened, while private health insurance expenditures increased due to the recession. Public financing patterns differed across the two states, as health funding in Maranhao continued to grow after the crisis years, as it was propped up by transfers to local governments. While public sector staff and beds per capita in Maranhao were not affected by the crisis, a decrease in public physicians was observed in Sao Paulo. Conclusion Our case study suggests that in a complex heterogeneous system, economic recessions reverberate unequally across its parts, as the effects are mediated by private spending, structure of the market and adjustments in public financing. Policies aimed at mitigating the effects of recessions in LMICs will need to take such differences into account.
- Revolving doors and conflicts of interest in health regulatory agencies in Brazil(2020) SCHEFFER, Mario C.; PASTOR-VALERO, Maria; RUSSO, Giuliano; HERNANDEZ-AGUADO, Ildefonso