Hyeda Adriano, da Costa Élide Sbardellotto Mariano, Kowalski Sérgio Candido
Post-graduation Program in Internal Medicine, Federal University of Paraná (UFPR), Street General Carneiro, 181, Central Building - 11th Floor, Alto da Glória, Curitiba, 80.060-900, Paraná, Brazil.
Public Health Department, Federal University of Paraná (UFPR), Curitiba, Brazil.
BMC Public Health. 2024 Dec 23;24(1):3573. doi: 10.1186/s12889-024-21115-2.
Disability insurance represents a significant economic burden within Brazil's social security system, yet long-term cost trends across disease groups remain understudied, hindering informed prevention and management strategies. Hospital costs, which account for approximately 40% of direct healthcare expenses, were selected as a comparative reference to contextualize the economic burden of disability insurance.
This study analyzes long-term cost trends of newly granted disability insurance by disease groups in Brazil, comparing them to public health system hospitalization expenses.
This ecological time series study applied the inflection point regression model and Annual Average Percentage Change (AAPC) analysis, utilizing open-access federal government datasets. Annual rates and costs of disability insurance and hospitalizations were examined, categorized by International Classification of Diseases, 10th Revision (ICD-10) groups, and standardized per insured individuals and the general population.
Between 2010 and 2019, the rate of temporary disability insurance granted (406 per 10,000 insureds) was 94% higher than permanent disability insurance (24 per 10,000), with women showing slightly higher rates but men incurring higher costs. The overall annual average rate of granted disability insurance (430 per 10,000 insureds) and its costs (BRL 5,084 per 100 insureds) were lower than those of hospitalizations (525 per 10,000 and BRL 5,870 per 100 Brazilians, respectively). Disabilities due to injuries, musculoskeletal disorders, and mental health problems had the highest rates (126, 89, and 40 per 10,000 insureds, respectively) and costs (BRL 1,455, 1,076, and 533 per 100 insureds, respectively). Neoplasms showed the only increasing trend in granted rates (AAPC 2.5%). The cost growth of granted disability insurance (AAPC 6.2%) was twice that of hospitalization costs (AAPC 2.9%), with disability insurance costs surpassing hospitalization expenses by 2018. Although most disease groups exhibited stable or declining trends in granted rates, costs increased across nearly all conditions.
The rising costs of disability insurance in Brazil highlight the growing economic burden of non-medical expenses and the need for evidence-based policies focused on prevention, management, and the sustainability of the social security system.
在巴西社会保障体系中，残疾保险是一项重大经济负担，但不同疾病组的长期成本趋势仍未得到充分研究，这阻碍了制定明智的预防和管理策略。医院成本约占直接医疗费用的40%，被选作比较参考，以了解残疾保险的经济负担情况。
本研究分析巴西按疾病组划分的新发放残疾保险的长期成本趋势，并与公共卫生系统的住院费用进行比较。
这项生态时间序列研究应用了拐点回归模型和年均百分比变化（AAPC）分析，使用的是可公开获取的联邦政府数据集。研究了残疾保险和住院的年发生率及成本，按国际疾病分类第十版（ICD-10）组进行分类，并按每被保险人及总人口进行标准化。
2010年至2019年期间，发放的临时残疾保险率（每10000名被保险人中有406例）比永久残疾保险率（每10000名中有24例）高94%，女性的发生率略高，但男性的成本更高。发放的残疾保险总体年均率（每10000名被保险人中有430例）及其成本（每100名被保险人5084巴西雷亚尔）低于住院率（每10000名中有525例）和成本（每100名巴西人中有5870巴西雷亚尔）。因伤、肌肉骨骼疾病和心理健康问题导致的残疾发生率最高（每10000名被保险人中分别为126例、89例和40例），成本也最高（每100名被保险人中分别为1455巴西雷亚尔、1076巴西雷亚尔和533巴西雷亚尔）。肿瘤是唯一发放率呈上升趋势的疾病组（AAPC为2.5%）。发放的残疾保险成本增长（AAPC为6.2%）是住院成本增长（AAPC为2.9%）的两倍，到2018年残疾保险成本超过了住院费用。尽管大多数疾病组的发放率呈稳定或下降趋势，但几乎所有疾病的成本都有所增加。
巴西残疾保险成本的上升凸显了非医疗费用经济负担的增加，以及需要制定以预防、管理和社会保障体系可持续性为重点的循证政策。
