LUCAS SALVADOR ANDRIETTA
Projetos de Pesquisa
Unidades Organizacionais
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
3 resultados
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- 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.
- 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.
- How the 'plates' of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil's Sao Paulo and Maranhao states(2020) RUSSO, Giuliano; LEVI, Maria Luiza; ALVES, Maria Teresa Seabra Soares de Britto e; OLIVEIRA, Bruno Luciano Carneiro Alves de; CARVALHO, Ruth Helena de Souza Britto Ferreira de; ANDRIETTA, Lucas Salvador; FILIPPON, Jonathan Goncalves; SCHEFFER, Mario Cesar; GARCIA, JonathanBackground Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. Methods Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (Sao Paulo) and impoverished (Maranhao) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. Results We found the concept of 'health sector crisis' to be politically charged among healthcare providers in Sao Paulo and Maranhao. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhao. Conclusions The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.