Perfil etário dos gastos públicos com saúde: uma análise temporal para o Brasil, segundo PIB per capita dos estados, sexo e tipos de gastos

Abstract

Understanding the long-term development of the age profile of healthcare expenditures, as well as the factors that can influence this distribution, becomes essential for more accurate health expenditure projections. In Brazil, none of these points has yet been fully investigated. To increase knowledge about the age distribution of healthcare expenditure in the country, this thesis analyzes the differences between the Federative Units regarding the age profile of public expenditure on hospital and outpatient services, focusing in particular on the role of GDP per capita. Also, changes of the profiles over time are investigated. The analysis covers the period from 2002 to 2016, for hospital expenses, and the years 2009 and 2016, for outpatient expenses. To assess the effect of GDP per capita on the shape of the curve, we investigate the relationship between GDP per capita and the ratio between the per capita expenditure of the elderly (65+) and that of the rest of the population (0-64). It is noted that, in 2002, the correlation between these variables is positive. However, this relationship is not the same over the period. The analysis of the age profiles over time shows that, in the richest UFs (belonging to the highest quartile of GDP per capita), there is a downward inflection of the curve at older ages. In the rest of the country, the movement is towards increasing the slope of the curve. These differences are proven through linear regression models. It is noteworthy that, in UFs belonging to the first three quartiles of GDP per capita, significantly higher expenditure growth rates in older ages are estimated, which does not reject steepening of the age profile of healthcare expenditure in most of the country. This result raises concerns about the financial sustainability of SUS since the pressure on expenditures could be significant if steepening continues. On the other hand, the evidence from the richest UFs indicates another possible trajectory for the age profile of healthcare expenditure in the long run, with the growth of GDP per capita in the country. The finding that the age profile of healthcare expenditure differs between UFs and that it has not remained constant in recent years is important so that these dimensions are also incorporated into analysis on the future trajectory of public healthcare expenditures in Brazil.