LUCAS SALVADOR ANDRIETTA
Projetos de Pesquisa
Unidades Organizacionais
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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- Growth, centralization, and financialization of Diagnostic and Therapeutic Support Services (SADT) in Brazil: a study of selected companies from 2008 to 2016(2022) MONTE-CARDOSO, Artur; ANDRIETTA, Lucas SalvadorThis article discusses the dynamics of the Diagnostic and Therapeutic Support Services subsector from 2008 to 2016 in Brazil. Through an exploratory approach, the study aimed to operationalize key concepts from the literature on the pattern of accumulation characterizing contemporary capitalism. The research focused on the activity of six Brazilian diagnostic companies in three main dimensions: (1) net worth; (2) accounting-finance; and (3) policy. The results reveal a subsector experiencing vigorous growth via increases in the volume and prices of the services provided. The evidence corroborates traits of a pattern of financialized accumulation, especially aggressive strategies of mergers and acquisitions by leading companies, with centralization as a result. However, some characteristics associated with the concept of financialization appear not to be relevant. The article also discusses the prospects for competition in activities in the Diagnostic and Therapeutic Support Services subsector and the possible effects for the effort to consolidate Brazilian Unified National Health System (SUS).
- 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.
- The Impact of the COVID-19 Pandemic on Physicians' Working Hours and Earnings in Sao Paulo and Maranhao States, Brazil(2022) OLIVEIRA, Bruno Luciano Carneiro Alves de; ANDRIETTA, Lucas Salvador; REIS, Regimarina Soares; CARVALHO, Ruth Helena de Souza Britto Ferreira de; ALVES, Maria Teresa Seabra Soares e; SCHEFFER, Mario Cesar; RUSSO, GiulianoEvidence exists on the health impacts of the current COVID-19 pandemic on health workers, but less is known about its impact on their work dynamics and livelihoods. This matters, as health workers-and physicians in particular-are a scarce and expensive resource in low- and middle-income countries (LMICs). Our cross-sectional survey set out to explore changes in working hours and earnings during the second year of the pandemic in a representative sample of 1183 physicians in Brazil's Sao Paulo (SP) and Maranhao (MA) states. Descriptive analysis and inferential statistics were employed to explore differences in working hours and earnings among public and private sector physicians across the two locations. The workloads and earnings of doctors working exclusively in the public sector increased the most in the second year of the epidemic, particularly in MA. Conversely, the largest proportion of private-only doctors in our sample saw a decrease in their working hours (48.4%, 95% CI 41.8-55.0), whereas the largest proportion of public-only doctors in MA saw an increase in their working hours (44.4%, 95% CI 38.0-50.8). Although earnings remained broadly stable in the public sector, a third of public sector-only physicians in MA saw an increase in their earnings (95% CI 24.4-36.2). More than half of private-only doctors across both states saw a decrease in their earnings (52.2%, 95% CI 45.6-58.8). The largest proportion of dual practitioners (the majority in Brazil and in our sample) maintained their pre-pandemic levels of income (38.8%, 95% CI 35.3-42.3). As public-sector doctors have been key in the fight against the pandemic, it is critical to invest in these cadres in order to develop epidemic preparedness in LMICs, and to find new ways to harness for-profit actors to deliver social benefits.
- Pensions and Commodification Under the PT Governments (2003-2015)(2020) ANDRIETTA, Lucas Salvador; LEMOS, Patricia Rocha; FAGNANI, EduardoAn analysis of the development of the Brazilian pension system's issues under the Partido dos Trabalhadores (Workers' Party-PT) governments focused on four main themes: austerity policy, payroll tax exemptions for employers, expansion of supplementary pensions, and union strategies associated with pension funds. The way the PT governments acted in these areas, despite expressing a different arrangement of interests from those of previous administrations that were self-declared neoliberal, did not change the general course of the comodification of social policy.
- Economic crisis and disparities in spending, supply, and use of public and private health services in Brazil from 2011 to 2019(2022) COSTA, Danielle Conte Alves Riani; MOREIRA, Jessica Pronestino de Lima; CARDOSO, Artur Monte; MATTOS, Leonardo Vidal; ANDRIETTA, Lucas Salvador; BAHIA, LigiaThis study sought to analyze the repercussions of the economic crisis on the public and private sec-tors of the Brazilian health system and perform a trend analysis of economic and care indicators, based on secondary data from official public sourc-es related to spending, the economic performance of health plans and insurance, and the supply and use of services. The results showed stagnation of public spending on health, as well as reduction of per capita public spending and of access to public health services. On the contrary, in a context of falling income and employment, health plans re-tained customers, increased revenues, profits, and their care production. The positive performance of companies, before and after the crisis, can be explained by the trend of maintaining public sub-sidies for the private sector and by financialized business strategies. We conclude that the actions of the Brazilian government during the crisis deep-ened the restriction of resources to the public sec-tor and favored the expansion of private services, which thus contributed to increase the discrepancy in access to public and private health services in the country.
- Financialization of the health sector in Brazil: theoretical and methodological challenges to the investigation of companies and business groups(2022) BAHIA, Ligia; POZ, Mario Dal; LEVCOVITZ, Eduardo; COSTA, Lais Silveira; MATTOS, Leonardo Vidal; ANDRIETTA, Lucas Salvador; MONTE-CARDOSO, Artur; TRAVASSOS, ClaudiaThe article describes the history of the response to the theoretical and methodological challenges in research on companies and corporate groups in the Brazilian health sector that reorganized their shareholding structures, diversified their activities, and expanded their financial operations. Such movements in corporate concentration and expansion were analyzed with an approach to the frame of reference for financialization in contemporary capitalism in the analysis of selected companies and corporate groups. Corporate strategies were classified in three dimensions: shareholding, financial, and accounting structure and influence on the public agenda and the respective indicators orienting the organization of information from diverse sources for companies and corporate groups from 2008 and 2017. The study provides a profile of the intense and complex process of corporate reorganization in the health sector. Still, the study's exploratory design and difficulties in access to information and selection of companies and corporate groups mean that the observations are necessarily preliminary.
- Médicos e terceirização: percepções de trabalhadores e gestores sobre as transformações recentes no mercado de trabalho(2022) LEVI, Maria Luiza; SOUSA, Juliana; ALMEIDA, Cristiane Jesus; MATSUMOTO, Karen; SUSSAI, Stefanie; ANDRIETTA, Lucas; SCHEFFER, Mário CésarAbstract The article examines recent trends in the way doctors enter the labor market in the light of the regulation of labor relations in the perception of key informants who work in the public and private sectors of the health system in the state of São Paulo, Brazil. The study showed that, in the perception of the interviewees, there is a growing trend of insertion of doctors as a legal entity conditioned by the regulation of labor relations and the contracting policy of establishments providing health care services. In general, the ‘pejotização’ (hiring free of labor rights/illegal hiring) of doctors was associated with the loss of autonomy of these professionals in relation to the terms of employment and the conditions for performing the work. The article concludes that the illegal hiring and insertion of doctors is presented as part of the more general movement of cheapening the workforce associated with outsourcing, and indicates that there is room for the exploitation of policies aimed at the management of workers who seek to attract and fix doctors in the Unified Health System.
- Planos de saúde: protagonistas da acumulação de capital na saúde brasileira(2020) ANDRIETTA, Lucas Salvador
- Physicians? income in Brazil: a study on information sources(2022) SCHEFFER, Mario; RIBEIRO, Felipe Oliveira Pinto; POZ, Mario Dal; ANDRIETTA, LucasOBJECTIVE: Data on physicians??? income are relevant for well-informed health policies, both due to their strategic role and the volume of resources that their activities represent to health systems. In Brazil, multiple sources of data measure the income of these professionals, each one with singularities that generate a complex and heterogeneous picture. This study explores the methodological aspects of different data sources, pointing to potentials and limitations to measuring the income of physicians. METHODS: We use the sources??? documentation and data on the average monthly income in 2019, by gender and macro region, from four distinct surveys: Continuous Pnad (National Household Sample Survey), RAIS (Annual Listing of Social Information), Medical Demographics, and IRPF (Personal Income Tax). RESULTS: The results confirm the heterogeneity of definitions, variables, and methodologies. The data set can evidence phenomena such as the income difference between men and women. Regional inequalities are evident; however, the data interpretation is less assertive. CONCLUSIONS: Although eventual gaps and discrepancies among sources can limit some strong conclusions, the analysis of different methodologies employed can suggest relevant hypotheses for in-depth studies.
- False collectivization of private health insurance: expansion, premium increases and judicialization (2014-2019)(2022) ANDRIETTA, Lucas SalvadorFalse collectivization is a growing phenomenon in the Brazilian health insurance market, stemming directly from regulatory decisions that affect the sector, especially the differences between the rules applicable to individual and collective contracts. Hence, this paper sought to analyze the recent evolution of this phenomenon under three aspects: (i) expansion of this type of contract, simultaneous to the disappearance of individual private health plans; (ii) premium increases for ""false collectives""; (iii) its judicialization and treatment in the jurispru-dence. Data was collected from the Brazilian Regulatory Agency for Private Health Insurance and Plans, detailed by company, between 2014 and 2019; the agency's Product Registration Technical Notes database, between 2015 and 2019; and primary data produced by analyzing rulings by the Sao Paulo Court of Justice, issued in 2018 and 2019. Results show the growth of ""false collectives,"" associated with the gradual disappearance of individual private health plans. They also demonstrate the gap between premium increases and the ceiling set by the Brazilian Regulatory Agency for Private Health Insurance and Plans for individual private health plans. Analysis of the rulings reveal that the Judiciary's understanding on the matter is not uniform, neither in terms of the outcome, nor of its legal reasoning. These findings support the interpretation that such contracts allow insures to circumvent relevant aspects of the sector's regulation, to impose higher premiums and, when contested in court, to evade consumer legislation.