Um estudo multinível sobre as filas para internações relacionadas com a gravidez, o parto e o puerpério no SUS

Abstract

Um estUdo mUltinível sobre as filas para internações relacionadas com a gravidez, o parto e o pUerpério no sUsAlexandre Marinho § Simone de Souza Cardoso ¤ resUmo Avaliamos os tempos de espera no Sistema Único de Saúde Brasileiro -SUS, para as internações relacionadas com o capítulo XV (gravidez, parto e puerpério) da CID-10 para os anos de 1999 e 2002. Primeiramente, estimamos os tempos de espera para atendimento com o auxílio de modelos de teoria das filas. Os tempos de espera são longos e elásticos em relação às taxas de chegada e às taxas de atendimento no SUS, e variam muito entre municípios e entre Estados. A seguir, estimamos, em modelos econométricos do tipo multinível, que o baixo peso ao nascer, as cesarianas, a taxa de fertilidade, o IDH e a importação de pacientes não residentes são positivamente correlacionados com os tempos de espera nas filas. Os exames do tipo pré-natal, a quantidade de enfermeiros e o gasto total per capita em saúde são negativamente correlacionados com esses tempos de espera.Palavras-chave: gravidez, parto e puerpério, filas de espera, Sistema Único de Saúde -SUS. abstractWe study the waiting times for pregnancy, childbirth and puerperal care in the years of 1999 and 2002 within the Brazilian National Health System -SUS. The average waiting times were estimated by queueing theory models, and they were found to be very long and highly elastic, with respect to arrival and service rates in the system. The waiting times also presented great variability across municipalities and across states. By using multilevel regression models we estimate that the frequency of low birthweight; the cesarian section rates; the total fertility rate; the Human Development Index -IDH; and the proportion of non-resident cases treated are positively associated with waiting times. On the contrary, the utilization of prenatal care; the rates of nurses with higher level of education available; and the per capita total expenditure on health are negatively associated with waiting times.

Intermunicipal inequities in access and use of secondary health services in the metropolitan area of Curitiba

“…This study demonstrated the complexity of the political interactions, which make the successful experiences of the hub municipality city unable to cross borders to its surroundings. The situation ends up negatively impacting the metropolitan health system itself, as it allows access to users who should be cared for in their own municipalities by emergency care, and especially aggravates clinical conditions that could be resolved much earlier and with utmost respect and dignity for the citizens 5,6,21 .…”

“…It was observed that the municipalities in the group with optimal living and health conditions were those that offered greater access to health services both in primary care and in specialized care. Studies such as the National Survey by Household Sample (PNAD) of 1998, 2003 and 2008, have reported that people living in more developed regions use more health services than those living in less favored areas 8,19,21 .…”

“…Inequities in the epidemiology profile and in the health care network suggest that municipalities have different realities in the quantity and quality of primary care services provided, especially when considering the differences between the supply of primary care consultations, the availability of professionals and infant mortality rates 5 . High-risk obstetrics is in limited supply in the Appointments Central of the hub municipality, resulting in repressed demand, which raises worries about the health of the mother and baby 5,21 .…”

Access to public health services and integral care for women during the puerperal gravid period period in Ceará, Brazil

“…The waiting time for a woman to receive healthcare plays an important role during puerperal pregnancy, on the health of pregnant women, mothers and newborns [11]. Research indicates that a waiting period of up to 6 h is considered clinically feasible to keep the prognosis unchanged [12, 13].…”

Efectos de protección financiera del sistema de salud pública y del seguro privado en Brasil

“…No hay cargos financieros asociados al uso del sistema público. Sin embargo, porque el sistema público excluye ciertos aspectos de la atención de salud (ocké-Reis, Silveira y Andreazzi, 2002) o si la calidad (Costa y García, 2003), la accesibilidad y el tiempo de espera (Marinhol y Cardoso, 2007) de los prestadores públicos son inadecuados, es posible que las familias prefieran gastar más dinero en prestadores privados y seguro de salud privado (Ribeiro, Barata y otros, 2006;Bós, 2007). La expansión de los planes de salud privados en Brasil durante las décadas de 1980 y 1990 estuvo relacionada por lo menos parcialmente con la mala calidad de los servicios de los proveedores públicos (Alves y Timmins, 2003), la que se deterioró durante la década de 1980 luego de una serie de crisis económicas, crecimiento económico lento y escasez de recursos públicos (Malta, Cecílio y otros, 2004).…”