Surgery in Brazilian Health Care: funding and physician distribution

Alonso, Nivaldo; Massenburg, Benjamin B.; Galli, Rafael Altafin; Sobrado, Lucas Faraco; Birolini, D

doi:10.1590/0100-69912017002016

Cited by 16 publications

(22 citation statements)

References 5 publications

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“…Reports from the LCoGS have shown an association between the density of SAO and the rate of surgical procedures or POMRs 2–4. Our data align with recent analyses of surgical care for adults in Brazil which showed wide disparities in manpower and surgical care 11 20. The Brazilian government has long recognised challenges with healthcare delivery across the country, and have implemented several programs to increase primary care access in rural areas 6 9 21…”

Section: Discussionsupporting

confidence: 85%

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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ObjectivesThe optimal size of the health workforce for children’s surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health.DesignThis study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde).Settings and participantsWe collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015.Primary and secondary outcome measuresWe performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models).FindingsThere were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11–0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children.ConclusionsWe found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.

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Section: Discussionsupporting

confidence: 85%

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

et al. 2020

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“…Our data aligns with recent analyses of surgical care for adults in Brazil, which showed wide disparities in manpower and surgical care delivery. [24, 25] The Brazilian government has long recognized challenges with disparities in health care delivery across the country, and have implemented several programs to increase health care access in rural areas, particularly for primary care services. [8, 12, 26] Our data suggests that there is a need to expand surgical care to minimize disparities in care delivery and improve health outcomes for children.…”

Section: Discussionmentioning

confidence: 99%

Disparities in surgical care for children across Brazil: Use of geospatial analysis

et al. 2019

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Background Health systems for surgical care for children in low- and middle-income countries remain poorly understood. Our goal was to characterize the delivery of surgical care for children across Brazil and to identify associations between surgical resources and childhood mortality. Methods We performed a cross-sectional, ecological study to analyze surgical care for children in the public health system ( Sistema Único de Saúde ) across Brazil from 2010 to 2015. We collected data from several national databases, and used geospatial analysis (two-step floating catchment, Getis-Ord-Gi analysis, and geographically weighted regression) to explore relationships between infrastructure, workforce, access, procedure rate, under-5 mortality rate (U5MR), and perioperative mortality rate (POMR). Results A total of 246,769 surgical procedures were performed in 6,007 first level/ district hospitals and 491 referral hospitals across Brazil over the study period. The surgical workforce is distributed unevenly across the country, with 0.13–0.26 pediatric surgeons per 100,000 children in the poorer North, Northeast and Midwest regions, and 0.6–0.68 pediatric surgeons per 100,000 children in the wealthier South and Southeast regions. Hospital infrastructure, procedure rate, and access to care is also unequally distributed across the country, with increased resources in the South and Southeast compared to the Northeast, North, and Midwest. The U5MR varies widely across the country, although procedure-specific POMR is consistent across regions. Increased access to care is associated with lower U5MR across Brazil, and access to surgical care differs by geographic region independent of socioeconomic status. Conclusions There are wide disparities in surgical care for children across Brazil, with infrastructure, manpower, and resources distributed unevenly across the country. Access to surgical care is associated with improved U5MR independent of socioeconomic status. To address these disparities, policy should direct the allocation of surgical resources commensurate with local population needs.

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“…This results in loss of productive lives and reduction of the population's well-being, interfering in the countries' economic development 1 . In addition, there are iniquities of access to anesthetic and surgical care among countries, since in developed countries the guarantee of access to surgery is greater than in low-and middle-income countries, especially in the population belonging to the poorest social strata 1,8,9 . In Brazilian literature, there is a shortage of studies that discuss epidemiological data on access to surgical care [10][11][12] . Among the few, there is a pioneer work covering a period of 13 years (1995-2007), which showed an increasing trend in the number of surgical interventions, related expenses and surgical mortality 10 .…”

Section: Introductionmentioning

confidence: 99%

“…These states receive residents of other Brazilian states and keep many of them throughout their professional career.The inadequate distribution of specialized human resources throughout Brazil may be due to the lack of attractiveness to work in the more remote regions. The lack of basic infrastructure in these areas is a barrier to the recruitment of surgical labor11 . In fact, the unequal distribution of the surgical workforce in Brazil certainly contributes to the poor quality of surgical care in certain regions.…”

mentioning

confidence: 99%

Tendência de internações e mortalidade por causas cirúrgicas no Brasil, 2008 a 2016.

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Tostes

et al. 2019

Rev. Col. Bras. Cir.

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RESUMO Objetivo: analisar a tendência de internações para realização de procedimentos cirúrgicos e de mortalidade cirúrgica no Brasil, no período de 2008 a 2016. Métodos: estudo ecológico, de séries temporais. Os dados sobre internações cirúrgicas e mortalidade entre 2008 e 2016 foram obtidos do Departamento de Informática do Sistema Único de Saúde. A análise de tendência foi realizada por meio de modelos de regressão polinomial. Resultados: foram realizados no período do estudo, 37.565.785 procedimentos cirúrgicos pelo Sistema Único de Saúde, uma média anual de 4.151.050 cirurgias. A média do coeficiente dos procedimentos cirúrgicos foi de 2,12 cirurgias por 100 habitantes/ano, com variação de 1,92 a 2,56 habitantes/ano entre as regiões do país. A taxa de mortalidade cirúrgica foi de 1,63%, com variação de 1,07% a 2,02% entre as regiões. Conclusão: constatou-se tendência significativa crescente dos procedimentos cirúrgicos realizados e de mortalidade cirúrgica; entretanto, o coeficiente de procedimentos cirúrgicos realizados é inferior ao preconizado pela meta internacional, com disparidades regionais no acesso aos cuidados cirúrgicos e na mortalidade, o que compromete a garantia da cobertura universal da saúde preconizada pelo Sistema Único de Saúde.

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Surgery in Brazilian Health Care: funding and physician distribution

Cited by 16 publications

References 5 publications

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Disparities in surgical care for children across Brazil: Use of geospatial analysis

Tendência de internações e mortalidade por causas cirúrgicas no Brasil, 2008 a 2016.

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