Introdução: A obesidade é um problema de saúde pública com múltiplos determinantes e consequências. Objetivos: 1) Analisar a relação entre a disponibilidade domiciliar de produtos alimentícios processados e ultraprocessados e a prevalência de excesso de peso e obesidade; 2) Descrever o gasto familiar privado com saúde, segundo a presença de indivíduos obesos nos domicílios; e 3) Estimar a influência da presença de indivíduos obesos nos domicílios sobre o gasto total com medicamentos (obtidos nos setores privado e público). Métodos: Tese composta por três manuscritos baseados em dados da Pesquisa de Orçamentos Familiares (POF) 2008-2009. O primeiro manuscrito utilizou os 550 estratos amostrais da POF como unidade de análise e modelos de regressão linear para avaliar a relação entre a disponibilidade calórica domiciliar de produtos processados e ultraprocessados e a prevalência de excesso de peso e de obesidade, ajustados para variáveis de confusão. Ainda, foram estimados os valores preditos dos desfechos, segundo quartos de disponibilidade de produtos ultraprocessados. Os demais manuscritos consideraram os 55.970 domicílios como unidade de análise. O segundo manuscrito descreveu a distribuição do gasto privado mensal com saúde, considerando o gasto com medicamentos e com assistência à saúde, segundo a presença de obesos nos domicílios. O terceiro analisou a influência da obesidade sobre o gasto mensal per capita com medicamentos, obtidos nos setores privado e público, por meio de modelo de duas partes (two-part model), com ajuste para variáveis de confusão. Resultados: Com relação aos determinantes alimentares, verificou-se que a disponibilidade de produtos ultraprocessados, mas não a de processados, foi positivamente associada com a prevalência de excesso de peso e obesidade. No quarto superior de disponibilidade de ultraprocessados a prevalência de obesidade foi 37 por cento superior à do quarto inferior. No que tange as consequências financeiras, verificou-se que, na presença de obesos no domicílio, o gasto privado com medicamentos total e específico para doenças crônicas foi maior, o mesmo não sendo observado para a assistência à saúde. Ainda, considerando os medicamentos obtidos por desembolso direto e no SUS, a presença de obesos nos domicílios resultou em um gasto com medicamentos 18 por cento superior. Conclusões: A disponibilidade de produtos ultraprocessados é um dos determinantes alimentares da obesidade, que tem como uma de suas consequências financeiras o maior gasto com medicamentos resultando em impacto negativo para o orçamento familiar e para o SUS. / Introduction: Obesity is a public health problem with multiple determinants and consequences. Objectives: 1) To analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight and obesity; 2) To describe the private spending on health, according to the presence of obese individuals in households; and 3) To estimate the influence of the presence of obese individuals in households over the total spending on medicines (obtained in the public and private sectors). Methods: Thesis comprising three manuscripts based on data from the Brazilian Household Budget Survey (HBS) 2008-2009. The first manuscript used the 550 sampling strata of HBS as the unit of study and linear regression models to evaluate the relationship between household caloric availability of processed and ultra-processed products and the prevalence of excess weight and obesity in the stratum, adjusted for confounding variables. Furthermore, predictive values of outcomes were estimated according to quartiles of the household caloric share from ultra-processed products. The other manuscripts considered the 55,970 households as the unit of study. The second manuscript described the distribution of private spending on health, considering the spending on medicines and healthcare, according to the presence of obese individuals in households. The third manuscript analyzed the influence of obesity on the household spending on medicines, obtained in the private and public sectors, using two-part models controlling for potential confounders. Results: Relative to the dietary determinants, we verified that the availability of ultra-processed products, but not of the processed, was positively associated with both outcomes studied. Moreover, the prevalence of obesity was 37 per cent higher in the upper quartile of availability of ultra-processed products, compared with the lower quartile. In relation to the financial consequences, we verified that the presence of obese individuals in households resulted in higher total private spending on medicines and on medicines for non-communicable diseases, but for healthcare this was not observed. Furthermore, considering the medicines obtained in SUS and by out-of-pocket, the presence of obese in households increased the total spending on medicines by 18 per cent . Conclusion: The availability of ultra-processed products is one of the determinants of obesity and one of the financial consequences of this disease is the larger spending on medicines, resulting in negative impact to the household budget and to the public health system

Thesis advisor: James Keenan / Public health is of critical importance in the world today, and particularly in the South, where developing states, unable to provide for the health of their citizens, continue to carry the global burden of disease. There is more funding available to global health than ever before. If these assets are going to be effective in advancing the health of the developing world, then they must be directed towards comprehensive measures that address the needs of entire populations, rather than disease-specific programs which do little to confront the challenges facing the world's poor. The latter approach may be dominating the field of public health, but horizontal, capacity-building programs can become the norm in this arena. In order to transform the global health-giving infrastructure, the public and political agendas in the United States and every other donor country must be reset. By transposing the tactics employed by activists of the most successful health campaign in history—that of the HIV/AIDS pandemic—onto the global health movement, proponents of this approach can position it on the agendas of states throughout the world, and construct sustainable healthcare systems that will attend to the plight of the current generation, as well as provide for the well-being of those to come. / Thesis (BA) — Boston College, 2008. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: International Studies. / Discipline: International Studies Honors Program.

This paper will examine specific processes involved within the decision-making process of how to allocate limited health care resources. I will start by discussing how in order to compare and differentiate between health states, we have created ranking systems, based on the health state’s impact on people’s quality of life, which health states need more care, and which can be most effectively treated. We evaluate impact on quality of life by assigning quality weights to years of life lived with that health state, which we call quality-adjusted life years, or QALYs. Next, I will discuss the problems with assigning quality weights to health states; specifically, the disability paradox, meaning the distinct differences between quality weights assigned by non-patients versus patients. After that, I will explain how depression defies the trend of the disability paradox, and causes our prior arguments about why patients and non-patients rate health states different to contradict themselves., This leads me to suggest that we should consider a different way of deciding between different quality weights. I examine the arguments for choosing higher or lower quality weights, and conclude that because we have a moral imperative to provide health care resources to those in need, particularly those who are disadvantaged, we should take the lower quality weights and err on the side of overspending on health states. Ultimately, this will create the greatest change in funding for health states like depression that go against the disability paradox. Finally, I address the economic trade-offs we have to consider if we make the decision to spend more on treating health states.

Submitted by Ana Carolina Alves da Costa Trindade (carol-futsal@hotmail.com) on 2018-06-12T13:32:21Z No. of bitstreams: 1 Dissertação Ana Carolina AC Trindade FINAL.pdf: 932582 bytes, checksum: a020e15203f1eeb655cd2cd537ea0ead (MD5) / Rejected by ALESSANDRA KUBA OSHIRO ASSUNÇÃO (alessandra@fct.unesp.br), reason: Solicitamos que realize correções na submissão seguindo as orientações abaixo: - Colocar folha de aprovação contendo as assinaturas dos membros da banca e a data de defesa. Ela virá depois da ficha catalográfica. Agradecemos a compreensão. on 2018-06-12T14:36:57Z (GMT) / Submitted by Ana Carolina Alves da Costa Trindade (carol-futsal@hotmail.com) on 2018-06-19T12:51:04Z No. of bitstreams: 1 Dissertação Final Ana Carolina Alves da Costa Trindade.pdf: 2222844 bytes, checksum: 789e364ad59c34b72906e8d295016274 (MD5) / Approved for entry into archive by Claudia Adriana Spindola null (claudia@fct.unesp.br) on 2018-06-19T13:04:42Z (GMT) No. of bitstreams: 1 trindade_acac_me_prud.pdf: 2222844 bytes, checksum: 789e364ad59c34b72906e8d295016274 (MD5) / Made available in DSpace on 2018-06-19T13:04:42Z (GMT). No. of bitstreams: 1 trindade_acac_me_prud.pdf: 2222844 bytes, checksum: 789e364ad59c34b72906e8d295016274 (MD5) Previous issue date: 2018-04-27 / O câncer de mama é a segunda neoplasia maligna mais frequente no mundo e a primeira entre as mulheres, constituindo-se um grave problema de saúde pública, devido as altas prevalências e ao gasto com o tratamento. O nível de atividade física é um dos determinantes do desenvolvimento e agravamento da doença, interferindo no uso de serviços de saúde bem como no gasto do tratamento. Objetivo: Analisar se o nível de atividade física está associado ao gasto com saúde, composição corporal, fadiga e dor, bem como comprar o gasto com saúde entre obesas e não obesas, fadiga e dor leve e intensa de mulheres sob hormonioterapia adjuvante com inibidores de aromatase contra o câncer de mama atendidas pelo SUS. Métodos: Amostra composta por 42 mulheres em tratamento hormonal adjuvante contra o câncer de mama com inibidores de aromatase. Avaliação do uso de serviço de saúde foi obtido por meio de informações auto-referidas em entrevistas norteadas por questionários e bancos de dados de preços em saúde, retroagindo 30 dias à entrevista. Foram realizadas medidas antropométricas, avaliação da composição corporal por densitometria óssea, nível de atividade física por acelerometria (MVPA), níveis de fadiga por meio do questionário proposto por Piper et al. (1998) e a sensação de dor pelo questionário breve de dor (IBD). A estatística descritiva foi composta por valores de média, desvio-padrão, mediana, diferença entre quartil. Correlações de Pearson e Spearman foram empregadas para analisar a relação entre MVPA e variáveis de composição corporal, sensação de fadiga, dor e gastos com serviços de saúde. O teste de Mann Whitney estabeleceu comparações entre os grupos, e as diferenças significativas foram reanalisadas pela análise de covariância (ANCOVA). Todas as análises foram feitas por meio do software estatístico SPSS (versão 22.0) e a significância estatística foi estabelecida em 5%. Resultados: na correlação entre MVPA e variáveis de composição corporal, fadiga, dor e gastos com saúde, pode-se observar relação negativa e significante para %GC (r=-0,477, p-valor=0,001), gasto com consultas médicas (r=-0,319, pvalor=0,039), gastos com exames (r=-0,314, p-valor=0,043) e gasto total das pacientes (r=- 0,361, p-valor=0,019). Nas comparações entre obesas e não obesas, foi possível identificar significância com valores superiores em obesas de gastos com consultas para doenças cardiovasculares (p-valor=0,003), mesmo após o ajuste. Nas comparações entre gastos com saúde segundo a sensação mais leve/moderada e mais intensa de dor, pode-se observar diferença significante, com valores superiores entre o grupo de dor intensa para gastos com medicamentos para câncer de mama (p-valor=0,043) e gasto total com medicamentos (pvalor=0,010) mesmo após o ajuste. Conclusão: conclui-se que a prática semanal de atividade física modera e vigorosa está inversamente relacionada ao %GC, gastos com consultas, exames e gasto total de pacientes em tratamento horminioterapico com inibidores de aromatase contra o câncer de mama. Além disso à obesidade esteve associada à maiores gastos com consultas para doenças cardiovasculares; e a dor intensa associou-se à maiores gastos com medicamentos para câncer de mama e gasto total com medicamentos. / Breast cancer is the second most frequent malignant neoplasm in the world and the first among women, constituting a serious public health problem, due to the high prevalence and expense associated with treatment. The level of physical activity is one of the determinants of the development and aggravation of the disease, interfering in the use of health services as well as in the treatment expenditure. Objective: To analyze whether the level of physical activity is associated with health expenditure, body composition, fatigue and pain, as well as to buy health spending between obese and non-obese women, fatigue and mild and intense pain of women under adjuvant hormone therapy with aromatase against breast cancer attended by SUS. Methods: A sample composed of 42 women in hormonal adjuvant treatment against breast cancer with aromatase inhibitors. Evaluation of the use of health service was obtained through self-referenced information in interviews guided by questionnaires and health price databases, with a 30-day interview. Anthropometric measurements, body composition evaluation by bone densitometry, physical activity level by accelerometry (MVPA), fatigue levels were performed using the questionnaire proposed by Piper et al. (1998) and the pain sensation by the brief pain questionnaire (IBD). A estatística descritiva foi composta por valores de média, desvio-padrão, mediana, diferença entre quartil. Correlações de Pearson e Spearman foram empregadas para analisar a relação entre MVPA e variáveis de composição corporal, sensação de fadiga, dor e gastos com serviços de saúde. O teste de Mann Whitney estabeleceu comparações entre os grupos, e as diferenças significativas foram reanalisadas pela análise de covariância (ANCOVA). Todas as análises foram feitas por meio do software estatístico SPSS (versão 22.0) e a significância estatística foi estabelecida em 5%. Results: in the correlation between MVPA and variables of body composition, fatigue, pain and health spending, a negative and significant relationship can be observed for% GC (r = -0.477, p-value = 0.001), spent with medical consultations (R = - 0.314, p-value = 0.043) and total patient expenditure (r = -0.361, p-value = 0.019). In the comparisons between obese and non-obese, it was possible to identify significance with higher values in obese patients of expenses for consultations for cardiovascular diseases (pvalue = 0.003), even after adjustment. In the comparisons between health spending according to the milder / moderate and more intense pain sensation, a significant difference can be observed, with higher values between the intense pain group for spending on breast cancer drugs (p-value = 0.043) and total drug expenditure (p-value = 0.010) even after adjustment. Conclusion: it is concluded that the weekly practice of moderate and vigorous physical activity is inversely related to the% GC, expenses with consultations, exams and total expenditure of patients undergoing horminioteraphy treatment with aromatase inhibitors against breast cancer. In addition, obesity was associated with higher expenses with consultations for cardiovascular diseases; and intense pain was associated with higher spending on breast cancer drugs and total drug spending.

Introdução: A obesidade é um problema de saúde pública com múltiplos determinantes e consequências. Objetivos: 1) Analisar a relação entre a disponibilidade domiciliar de produtos alimentícios processados e ultraprocessados e a prevalência de excesso de peso e obesidade; 2) Descrever o gasto familiar privado com saúde, segundo a presença de indivíduos obesos nos domicílios; e 3) Estimar a influência da presença de indivíduos obesos nos domicílios sobre o gasto total com medicamentos (obtidos nos setores privado e público). Métodos: Tese composta por três manuscritos baseados em dados da Pesquisa de Orçamentos Familiares (POF) 2008-2009. O primeiro manuscrito utilizou os 550 estratos amostrais da POF como unidade de análise e modelos de regressão linear para avaliar a relação entre a disponibilidade calórica domiciliar de produtos processados e ultraprocessados e a prevalência de excesso de peso e de obesidade, ajustados para variáveis de confusão. Ainda, foram estimados os valores preditos dos desfechos, segundo quartos de disponibilidade de produtos ultraprocessados. Os demais manuscritos consideraram os 55.970 domicílios como unidade de análise. O segundo manuscrito descreveu a distribuição do gasto privado mensal com saúde, considerando o gasto com medicamentos e com assistência à saúde, segundo a presença de obesos nos domicílios. O terceiro analisou a influência da obesidade sobre o gasto mensal per capita com medicamentos, obtidos nos setores privado e público, por meio de modelo de duas partes (two-part model), com ajuste para variáveis de confusão. Resultados: Com relação aos determinantes alimentares, verificou-se que a disponibilidade de produtos ultraprocessados, mas não a de processados, foi positivamente associada com a prevalência de excesso de peso e obesidade. No quarto superior de disponibilidade de ultraprocessados a prevalência de obesidade foi 37 por cento superior à do quarto inferior. No que tange as consequências financeiras, verificou-se que, na presença de obesos no domicílio, o gasto privado com medicamentos total e específico para doenças crônicas foi maior, o mesmo não sendo observado para a assistência à saúde. Ainda, considerando os medicamentos obtidos por desembolso direto e no SUS, a presença de obesos nos domicílios resultou em um gasto com medicamentos 18 por cento superior. Conclusões: A disponibilidade de produtos ultraprocessados é um dos determinantes alimentares da obesidade, que tem como uma de suas consequências financeiras o maior gasto com medicamentos resultando em impacto negativo para o orçamento familiar e para o SUS. / Introduction: Obesity is a public health problem with multiple determinants and consequences. Objectives: 1) To analyze the relationship between household availability of processed and ultra-processed products and the prevalence of excess weight and obesity; 2) To describe the private spending on health, according to the presence of obese individuals in households; and 3) To estimate the influence of the presence of obese individuals in households over the total spending on medicines (obtained in the public and private sectors). Methods: Thesis comprising three manuscripts based on data from the Brazilian Household Budget Survey (HBS) 2008-2009. The first manuscript used the 550 sampling strata of HBS as the unit of study and linear regression models to evaluate the relationship between household caloric availability of processed and ultra-processed products and the prevalence of excess weight and obesity in the stratum, adjusted for confounding variables. Furthermore, predictive values of outcomes were estimated according to quartiles of the household caloric share from ultra-processed products. The other manuscripts considered the 55,970 households as the unit of study. The second manuscript described the distribution of private spending on health, considering the spending on medicines and healthcare, according to the presence of obese individuals in households. The third manuscript analyzed the influence of obesity on the household spending on medicines, obtained in the private and public sectors, using two-part models controlling for potential confounders. Results: Relative to the dietary determinants, we verified that the availability of ultra-processed products, but not of the processed, was positively associated with both outcomes studied. Moreover, the prevalence of obesity was 37 per cent higher in the upper quartile of availability of ultra-processed products, compared with the lower quartile. In relation to the financial consequences, we verified that the presence of obese individuals in households resulted in higher total private spending on medicines and on medicines for non-communicable diseases, but for healthcare this was not observed. Furthermore, considering the medicines obtained in SUS and by out-of-pocket, the presence of obese in households increased the total spending on medicines by 18 per cent . Conclusion: The availability of ultra-processed products is one of the determinants of obesity and one of the financial consequences of this disease is the larger spending on medicines, resulting in negative impact to the household budget and to the public health system

No description available.

Il est admis qu’avoir une mauvaise santé est une des causes principales de pauvreté,particulièrement dans les pays à faible et moyen revenus. Une des raisons de ce constat est une absence de protection financière. L’objectif de cette thèse est de discerner le rôle que l'assurance maladie pourrait jouer dans l'organisation du système de protection financière de la santé. La thèse se compose de deux parties. La première partie aborde les problèmes liés au financement de santé d’un point de vue global. Le chapitre 1 apporte des discussions théoriques sur trois thèmes: 1) les spécificités des risques de la consommation médicale qui rendent la gestion du risque par l’assurance maladie privé difficile, 2) le rôle du gouvernement et du marché dans la répartition des ressources de santé. 3) les options pour l'organisation du financement de la santé. Le chapitre 2 présente une comparaison statistique sur la performance des systèmes de financement de la santé entre des pays à contextes socio-Économique différents. Les discussions sont menées autour de trois aspects du financement de la santé: la disponibilité des ressources,l'organisation du financement de la santé, et la couverture de la protection financière. La deuxième partie qui comporte trois chapitres étudie l'évolution du système de financement de la santé dans un pays donné: la Chine. Le chapitre 3 présente l'histoire du système de financement de la santé en Chine depuis 1950. Il nous aide à comprendre les défis dans le financement de la santé suscités par la réforme économique. Le chapitre 4 porte sur une étude empirique de la répartition de la charge financière de la santé en Chine dans les années 1990. Il illustre les résultats directs de la baisse du financement public et de l'augmentation des paiements directs sur le bienêtre de la population. Le chapitre 5 présente la réforme de l'assurance maladie lancée par le gouvernement depuis la fin des années 1990. L'objectif est d'estimer l'impact de la mise en oeuvre du nouveau système rural d’assurance médical (NRMCS) sur les activités et la structure financière de ces hôpitaux. Une analyse d'impact est réalisée sur un échantillon de 24 hôpitaux dans la préfecture de Weifang, au Nord de la Chine. Nous concluons que le système d'assurance maladie permet un partage des responsabilités financières entre prestataires de services, patient consommateurs et acheteurs de services. Elle inclut à la fois les agents publics et privés dans la contribution au financement de santé, ce qui rend chaque partie plus responsable vis-À-Vis de son comportement en raison des risques qu'il doit assumer du fait de la consommation médicale.Cependant, il est nécessaire de noter que l’assurance maladie sociale n’est qu’une option parmi d’autres systèmes de financement de la santé. La mise en oeuvre de ce système exige un certain niveau de développement socio-Économique. L’assurance maladie ne conduit pas systématiquement à une meilleure performance du financement de la santé si elle n'est pas accompagnée de réformes quant au paiement au fournisseur ou au système de prestation de services. L'engagement du gouvernement et des capacités institutionnelles sont également des facteurs clés pour le bon fonctionnement du système. / It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-Economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-Consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-Economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system.

It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system.

As one of the largest public health system in the world, whose assumptions suggest: universal, full, equitable and free coverage, it is expected that the Unified Health System has its quality affected by several socioeconomic factors. Therefore, the objective of this research is to assess certain socioeconomic variables have impacts on the quality of the Unified Health System, as measured by the Unified Health System Development Index, in Brazilian municipalities, and also to know the magnitude and the direction of these impacts. From method of Ordinary Least Squares (OLS) were estimated the effects of the variables analyzed (spending on health per capita, Gross Domestic Product per capita, literacy rate, proportion of elderly proportion of motorcycles and biomes) on Unified Health System Development Index. The result that can be seen is that all variables have an impact on this index, with the expenditure on health per capita variable with the greatest impact on Unified Health System quality among the quantitative variables. The qualitative biome also impacts on the quality of Unified Health System, unlike the homogeneous groups of municipalities that did not have statistically significant coefficients. / Por ser um dos maiores sistemas públicos de saúde do mundo, cuja as premissas sugerem: cobertura universal, integral, igualitária e gratuita, acredita-se que o Sistema Único de Saúde (SUS) tenha sua qualidade afetada por diversos fatores socioeconômicos. Portanto, o objetivo desta pesquisa é avaliar se determinadas variáveis socioeconômicas municipais têm impactos na qualidade do Sistema Único de Saúde, medido pelo Índice de Desenvolvimento do SUS (IDSUS), nos municípios brasileiros, e, também, de saber qual a magnitude e a direção desses impactos. A partir do método dos Mínimos Quadrados Ordinários (MQO) foram estimados os efeitos das variáveis analisadas (gasto com saúde per capita, Produto Interno Bruto (PIB) per capita, taxa de analfabetismo, proporção de idosos, proporção de motocicletas e biomas) sobre o IDSUS. O resultado que se pode constatar é que todas as variáveis analisadas têm algum impacto sobre o referido índice, sendo o gasto com saúde per capita a variável com maior impacto na qualidade do SUS, dentre as variáveis quantitativas analisadas. A variável qualitativa bioma também tem impacto sobre a qualidade do SUS, diferentemente dos grupos homogêneos de municípios, que não tiveram coeficientes estatisticamente significantes.

Orientador: Nelson Rodrigues dos Santos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T03:08:01Z (GMT). No. of bitstreams: 1 Soares_Adilson_D.pdf: 1612521 bytes, checksum: 848fcbad1b0641820996aa5bb9623f12 (MD5) Previous issue date: 2014 / Resumo: Neste trabalho discutem-se questões relativas ao financiamento e à alocação de recursos no SUS, à luz das políticas de governo e das reformas propostas no arcabouço legal e no aparelho do Estado na Constituição Federal de 1988 e no período pós-Constituição. Trata-se de um estudo exploratório, desenvolvido com base em documentos e análise de dados obtidos e/ou construídos a partir de fontes primárias, secundárias, fontes oficiais, imprensa, e sítios de interesse. A estratégia metodológica adotada para o desenvolvimento da pesquisa permitiu a utilização de um modelo de triangulação de métodos. Os dados quantitativos foram apresentados por meio da construção de uma série histórica, para os anos de 1995 a 2012, organizados em médias anuais por períodos, que correspondem aos governos dos presidentes FHC, Lula e início do governo Dilma. Na análise dos dados, buscou-se estabelecer comparativos em valores absolutos e percentuais entre os Gastos com Saúde, Orçamento, Produto Interno Bruto, Receita, Carga Tributária, Dívida Pública e Superávit Primário. Na análise dos dados qualitativos, buscou-se identificar como se deu a concepção e o desenvolvimento do SUS, diante de dois projetos políticos a princípio distintos e em disputa. Analisou-se o marco legal do Sistema Único de Saúde e suas alterações, o contexto político e econômico em que emerge e se desenvolve o SUS e os gastos com saúde, com o propósito de identificar o movimento instituinte e o modelo instituído no SUS, em um contexto marcado pelo domínio das políticas neoliberais. Os resultados do estudo revelam que a execução da política econômica brasileira, principalmente no campo da política fiscal, se orientou, ao longo do período estudado pelos preceitos do receituário neoliberal hegemônico, tendo o financiamento do SUS acompanhado esse movimento. Manifestou-se no estudo o caráter antagônico do Sistema Único de Saúde; revelado pela concepção inaugural do SUS, ora marginal ora alinhada com a política econômica hegemônica ¿ neoliberal; e pela execução da política de saúde alinhada com a política neoliberal. A consequência dessa política foi o subfinanciamento do SUS nos governos FHC, Lula e se manifesta a mesma tendência no início de governo da presidente Dilma Roussef. O estudo conclui que o subfinanciamento do sistema de saúde no Brasil, no período de 1995 a 2012, se manifestou como uma política de Estado e não de um governo específico. Nas considerações finais o autor chama a atenção para a importância da conquista de mais recursos para a saúde não como um fim em si; na medida em que no horizonte político o projeto de lei que tramita no legislativo federal propondo mais recursos para a saúde não trará, de acordo com os dados estimados e apresentados nesta tese, uma mudança no paradigma de gastos públicos no setor saúde no Brasil; mas pelo efeito demonstração que uma mobilização dessa natureza pode trazer para as transformações no SUS, na medida em que pode acalorar a pauta de discussões deste sistema e despertar outros setores para a importância da consolidação do direito à saúde / Abstract: This paper discusses issues related to funding and resource allocation in the SUS, in the light of government policies and reforms proposed in the legal framework and the State apparatus in the Federal Constitution of 1988 and the post-Constituition period. This is an exploratory study, developed on the basis of documents and analysis of data obtained and/or constructed from primary sources, secondary sources, press officers and sites of interest. The methodological approach adopted for the development of the research allowed the use of a model of triangulation of methods. Quantitative data were presented through the construction of a historical series, for the years 1995 to 2012, organized into annual averages for periods, which correspond to the Governments of Presidents FHC, Lula and beginning of Rousseff's Government. In data analysis, we sought to establish comparatives in absolute values and percentages between Health Spending, Budget, Gross Domestic Product, Income, Tax Burden, Public Debt and a Primary Surplus. In the analysis of qualitative data, we sought to identify how the design and development of the SUS, in front of two political projects, distinct at first, and in dispute. We analyzed the legal framework of the Unified Health System (SUS) and its changes, the political and economic context in which the SUS and health spending emerges and develops, with the purpose of identifying the movement and set up model stablished in SUS, in a context marked by the dominance of neoliberal policies. The results of the study show that the implementation of the Brazilian economic policy, mainly in the field of fiscal policy, was directed, over the period studied by the precepts of liberal hegemonic prescription, and the funding from SUS has accompanied this movement. Manifested in the study an antagonistic character of the Unified Health System (SUS); revealed by the inaugural design of the SUS, sometimes marginal, sometimes well aligned with the hegemonic economic policy ¿ neoliberal; and the implementation of health policy in line with the neoliberal policies. The consequences of that policy was the underfunding of SUS in FHC, Lula Governments and it manifests the same trend in the early Government of President Dilma Roussef. The study concludes that the underfunding of the Health System, in Brazil, in the period of 1995 to 2012, manifested as a State policy, not a particular Government. In the final considerations, the author points out, among other things, to the importance of the achievement of more resources for health not as an end in itself; to the extent that the political horizon the "Bill" that clears the federal legislature proposing more resources for health will not bring, according to the estimated data and presented in this thesis, a change in the paradigm of public spending in the health sector in Brazil; but a demonstration effect that a mobilization of this nature can bring to the transformations in the SUS, insofar as it can inflame the agenda of discussions of this system and other sectors for the importance of consolidating the right to health / Doutorado / Política, Planejamento e Gestão em Saúde / Doutor em Saude Coletiva