Moreira Leonardo, de Lima João Vitor Marques Teodoro, Silvestrini Murilo Mazzotti, Sarti Flavia Mori
School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil.
Institute of Economics, State University of Campinas, Campinas 13083-857, Brazil.
Healthcare (Basel). 2024 Nov 22;12(23):2335. doi: 10.3390/healthcare12232335.
: The Brazilian health system provides healthcare financed by the public and private sector, being the first designed to encompass universal healthcare coverage delivered to the population without charge to patients (Sistema Único de Saúde, SUS), whilst the second refers to healthcare coverage delivered for individuals with the capacity to pay for assistance through health insurance or out-of-pocket disbursements. Health insurance companies with beneficiaries receiving publicly financed healthcare from the SUS are required to provide the reimbursement of healthcare expenditures to the government, considering that the health insurance beneficiaries obtain deductions of income taxes designed to fund the SUS. Therefore, the study investigated patterns of healthcare utilization and public expenditure due to the use of public healthcare by beneficiaries of health insurance between 2003 and 2019. : Datasets including annual information on healthcare utilization by beneficiaries of health insurance from the National Agency of Supplementary Health (Agência Nacional de Saúde Suplementar, ANS) were organized into a single database to allow for the identification of patterns of interest to inform public policies of health. The empirical strategy adopted included the estimation of regression models and agglomerative hierarchical cluster analysis to identify factors associated with public sector expenditure. : The regression results indicated lower expenditure with female patients, particularly children and adolescents under 20 years old, receiving treatment in public sector facilities linked to the federal government. The cluster analysis showed five types of health insurance beneficiaries with a higher level of healthcare utilization, being three clusters referring to medium complexity procedures with lower public expenditures, and two clusters with higher public expenditures, one cluster that refers to high complexity procedures, and one cluster referring to health insurance schemes without hospitalization. : The findings of the study highlight the existence of patterns of healthcare utilization by health insurance beneficiaries that may compromise the sustainability of public funding within the Brazilian health system.
巴西医疗体系提供由公共部门和私营部门资助的医疗服务，前者旨在实现全民免费医疗覆盖（统一医疗体系，SUS），后者则是为有能力通过医疗保险或自掏腰包支付医疗费用的个人提供医疗覆盖。从SUS获得公共资助医疗服务的医疗保险受益人所在的保险公司，需要向政府偿还医疗支出，因为医疗保险受益人可享受旨在资助SUS的所得税减免。因此，本研究调查了2003年至2019年间医疗保险受益人使用公共医疗服务的医疗利用模式和公共支出情况。：将包含国家补充卫生机构（Agência Nacional de Saúde Suplementar，ANS）提供的医疗保险受益人年度医疗利用信息的数据集整理到一个单一数据库中，以便识别相关模式，为卫生公共政策提供参考。所采用的实证策略包括估计回归模型和凝聚层次聚类分析，以确定与公共部门支出相关的因素。：回归结果表明，在与联邦政府相关的公共部门设施接受治疗的女性患者，尤其是20岁以下的儿童和青少年，支出较低。聚类分析显示，有五种医疗保险受益人的医疗利用水平较高，其中三个聚类涉及中等复杂程度的程序且公共支出较低，另外两个聚类的公共支出较高，一个聚类涉及高复杂程度的程序，另一个聚类涉及不住院的医疗保险计划。：该研究结果凸显了医疗保险受益人存在的医疗利用模式，这可能会损害巴西医疗体系内公共资金的可持续性。
