COVID Health Structure Index: The Vulnerability of Brazilian Microregions

Abstract

Many developing countries have highly unequal health systems across their regions. The pandemic of COVID-19 brought an additional challenge, as hospital structures equipped with doctors, intensive care units and respirators are not available to a sufficient extent in all regions. Using Data Envelopment Analysis, we create a COVID Index to verify whether the hospital structures in 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. The results indicate that hospital structures in the poorest microregions were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo). The Southeast states could relocate hospital resources or even patients between their regions. The relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions’ hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.

COVID-19 and the efficiency of health systems in Europe

“…For the relaxation phase , government effectiveness is positively associated with the efficiency score, this emphasizing, once again, the relevance of making appropriate decisions in the moments that require such actions; instead, it seems that cultural factors such as power distance negatively influence the efficiency of health systems, which means that there are variations in compliance with safety measures depending on inequalities in society (related to education, income, etc.). Our results are similar to those obtained by [ 9 , 14 , 16 , 28 , 29 ], for which show that the prompt and effective intervention of governments and the adherence of the population to these measures were decisive factors in combating COVID-19.…”

“…The other independent variables do not influence the efficiency score, having a significance threshold higher than 0.05. The results obtained are similar to those of [ 9 , 15 , 18 , 20 , 21 , 25 , 29 ] which showed that the effects of COVID-19 were stronger among the elderly and sick population.…”

“…The literature contains studies that analyse the efficiency of public health systems, mainly at the microeconomic level, i.e., patient, hospitals, measures and health programs [ 6 , 7 ], as well as comparative research at the macro level, between states or regions [ 8 , 9 ] however, the latter are much fewer than the former. Efficiency in the health sector needs to be debated by experts in order to identify drivers, respectively obstacles, in the way of health systems.…”

“…analyzing 543 micro-regions in Brazil, it is concluded that richer regions, although more severely affected by the pandemic, were able to treat and reallocate patients better than poor regions, thus showing that socio-economic inequalities have an important impact in this health crisis [ 9 ];…”

Trend analysis of COVID-19 cases in Pakistan

“…As Pakistan is a developing and highly populated country with insufficient economic condition and poor healthcare system. Studies showed that disease outbreaks greatly challenge the health infrastructure of the countries for instance insufficient health policies, lack of health care system, weak governance and general public risking attitude towards preventative measures, increased the likelihood for worst scenario [19][20][21][22][23] . Firouzbakht, Omidvar [24] conducted a web-based survey to assess the factor affecting the COVID-19 preventative behaviour and concluded that 50% of the respondents have not taken seriously, the COVID-19 preventative measures i.e., wearing mask, washing hand and wearing gloves.…”