Três ensaios de economia da saúde

Abstract

This thesis is composed of three articles on Health Economics. The first document seeks to analyze the possible spatial integration of the network of public hospitals in Colombia, with the aim of analyzing whether there is efficiency when remitting patients according to the type of care demanded in the hospital. Based on the estimation of a spatial panel model, we analyzed the total of hospitals that make up the public offer system, concluding that although there may be a certain degree of transfer in patient care, it is very low for the case of general medicine, given that the spatial coefficient of the SDM model, rho is less than one. Once the analysis for the static model was estimated, the dynamic SAR and SDM model was estimated, a dynamic model was estimated that decomposed the effects in direct and indirect, where it was evidenced that there is a long-term spatial distribution effect for the attention of appointments of general medicine determined by the number of health care personnel of the 4 closest hospitals, however the presence of transshipments was not found in the short term in general medical care among the hospitals of the public network, since these are the ones that behave as institutions providing basic services, without having a trained staff that allows better care from the development of better medical practices. The same article calculates the SDM, SAR, SAC models for highly complex hospitals, having as dependent variable the number of surgeries performed with a normalized distance matrix of 8 neighbors, concluding that the number of emergencies attended by the hospital affects negative in the total of surgeries practiced, that is to say, the hospitals of high level of complexity carry out in their majority programmed surgeries, nevertheless a change in the total of emergencies. In order to control the existence of random spatial effects in the error, the model is estimated. GSPRE shows that there is a spillover effect that varies little in the time given by the coefficient lambda = 0,10, which is statistically significant but small , and that if there are shocks over time that significantly modify the behavior between hospitals. This type of variation is related as it is expressed cite baltagi2013generalized with technological shocks, changes in the facilities of hospitals that allow to significantly change the capacity to perform surgeries. The second article analyzes decentralization in the health system, studying one of the main objectives in public policy: the prevention of diseases, analyzing the effectiveness of the program in performing preventive cytopathological exams in women, given the availability of resources in the basic care teams located in all the municipalities of Brazil. Based on the analysis of the National Melhoria do Acceso e da Qualidade de Atenção Básica -AMPprogram, a factorial analysis is performed that calculates the covariances between the personnel, medical and physical supplies available in the equipment, as well as features such as race, income, literacy level, among others, the decision of women to undergo the cytopathological examination, a model is realized that includes a system of structural equations. It concludes that decentralization is due more than to a system formed in a correct way according to national and international parameters, to a management of the bureaucrats, as it was shown, in the states where there is a deficit or an adequate number of health posts , the estimate had positive coefficients, but this beyond the flow of resources, depends on the political will of each one of the government spheres to increase the number of health establishments or health programs. In this way, and in family health programs such as the performance of cytopathological tests, it is taking place in the basic care network in Brazil, in compliance with the Health Pact established for Brazil. Finally, the analysis of the demand for private health plans is made from different variables of individual, family, social, economic and geographical characterization of individuals and units of family consumption or Brazilian households, based on a logit model. It allows determining that individuals of the amarela race have the highest probability of choosing to demand a private health plan in Brazil, specifically in the North, South and Southeast regions of the country. Thus, in the Southeastern region of Brazil, at a level of significance of 1% the probability of demanding private health insurance is greater for people of that skin color or race, an additional control is created: division by range of monthly per capita income level; In this way, it is observed how the possibility of demanding private health plans varies according to the race declared by the individuals associated with the level of income received in per capita terms by the Brazilian family consumption units, which reflects that with a per capita income monthly of 200 reais, regardless of the declared race, all individuals have the same probability of demanding a private health plan in Brazil.