Envelhecimento populacional e gastos com internação do SUS: uma análise realizada para todas as regiões do país entre 2000 e 2010

Abstract

The world population has been experiencing a gradual aging process in its age structure due to the sharp decrease in the fertility and mortality rates over the last decades. This process, basically present in all countries around the world, brings worries about the increasing of healths expenditure. The goal of this thesis is to measure the effects of age structure changes in the hospitalizations expenditure at SUS. For this purpose, three exercises of decomposing the hospitalizations expenditure were done. The first one updates the Berenstein and Wajnman (2008) work to 2010, which decomposes the difference between the expenditures with hospitalizations at Curitiba and Belém in the year 2000. The second exercise decomposes the expenditures with hospitalizations between two regions, South and Northest, in the years 2000 and 2010. The third and last one decomposes the hospitalizations expenditures of all regions in the country between the years 2000 and 2010. To demonstrate the effects by diseases groups, that decomposition is also applied to three groups of diseases: Infectious and parasitic diseases, neoplasm and circulatory. The data is taken from the Hospitals Information System (SIH-SUS). The method adopted was Berenstein and Wajnman (2008), which decomposes the expenditures with hospitalizations at three effects: price effect (by the difference between the average costs), rate effect (by the difference between hospitalizations rates) and the composition effect (by the difference between the age structure). In general, the results show the importance of the price effect for differences in SUS hospitalizations expenditure, that is, the great disparity of average costs between two localities or two years. Despite these results, the comparison effect has a negative effect in the majority of the exercises done in this thesis, appearing to have a major role in the rising of the expenditure with hospitalization caused by circulatory diseases and neoplasm in all regions in the country between 2000 and 2010.