Submitted by PPG Economia do desenvolvimento (economia-pg@pucrs.br) on 2018-05-14T20:42:09Z No. of bitstreams: 1 ANNE_JULISSA_ADUBER_PENALOZA_TES.pdf: 3031751 bytes, checksum: 27dc405ec8dc4ef1271f4c34d565e5c6 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-05-18T15:00:23Z (GMT) No. of bitstreams: 1 ANNE_JULISSA_ADUBER_PENALOZA_TES.pdf: 3031751 bytes, checksum: 27dc405ec8dc4ef1271f4c34d565e5c6 (MD5) / Made available in DSpace on 2018-05-18T15:11:47Z (GMT). No. of bitstreams: 1 ANNE_JULISSA_ADUBER_PENALOZA_TES.pdf: 3031751 bytes, checksum: 27dc405ec8dc4ef1271f4c34d565e5c6 (MD5) Previous issue date: 2017-10-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / This thesis is composed of three articles on Health Economics. The first document seeks to analyze the possible spatial integration of the network of public hospitals in Colombia, with the aim of analyzing whether there is efficiency when remitting patients according to the type of care demanded in the hospital. Based on the estimation of a spatial panel model, we analyzed the total of hospitals that make up the public offer system, concluding that although there may be a certain degree of transfer in patient care, it is very low for the case of general medicine, given that the spatial coefficient of the SDM model, rho is less than one. Once the analysis for the static model was estimated, the dynamic SAR and SDM model was estimated, a dynamic model was estimated that decomposed the effects in direct and indirect, where it was evidenced that there is a long-term spatial distribution effect for the attention of appointments of general medicine determined by the number of health care personnel of the 4 closest hospitals, however the presence of transshipments was not found in the short term in general medical care among the hospitals of the public network, since these are the ones that behave as institutions providing basic services, without having a trained staff that allows better care from the development of better medical practices. The same article calculates the SDM, SAR, SAC models for highly complex hospitals, having as dependent variable the number of surgeries performed with a normalized distance matrix of 8 neighbors, concluding that the number of emergencies attended by the hospital affects negative in the total of surgeries practiced, that is to say, the hospitals of high level of complexity carry out in their majority programmed surgeries, nevertheless a change in the total of emergencies. In order to control the existence of random spatial effects in the error, the model is estimated. GSPRE shows that there is a spillover effect that varies little in the time given by the coefficient lambda = 0,10, which is statistically significant but small , and that if there are shocks over time that significantly modify the behavior between hospitals. This type of variation is related as it is expressed cite baltagi2013generalized with technological shocks, changes in the facilities of hospitals that allow to significantly change the capacity to perform surgeries. The second article analyzes decentralization in the health system, studying one of the main objectives in public policy: the prevention of diseases, analyzing the effectiveness of the program in performing preventive cytopathological exams in women, given the availability of resources in the basic care teams located in all the municipalities of Brazil. Based on the analysis of the National Melhoria do Acceso e da Qualidade de Aten??o B?sica -AMPprogram, a factorial analysis is performed that calculates the covariances between the personnel, medical and physical supplies available in the equipment, as well as features such as race, income, literacy level, among others, the decision of women to undergo the cytopathological examination, a model is realized that includes a system of structural equations. It concludes that decentralization is due more than to a system formed in a correct way according to national and international parameters, to a management of the bureaucrats, as it was shown, in the states where there is a deficit or an adequate number of health posts , the estimate had positive coefficients, but this beyond the flow of resources, depends on the political will of each one of the government spheres to increase the number of health establishments or health programs. In this way, and in family health programs such as the performance of cytopathological tests, it is taking place in the basic care network in Brazil, in compliance with the Health Pact established for Brazil. Finally, the analysis of the demand for private health plans is made from different variables of individual, family, social, economic and geographical characterization of individuals and units of family consumption or Brazilian households, based on a logit model. It allows determining that individuals of the amarela race have the highest probability of choosing to demand a private health plan in Brazil, specifically in the North, South and Southeast regions of the country. Thus, in the Southeastern region of Brazil, at a level of significance of 1% the probability of demanding private health insurance is greater for people of that skin color or race, an additional control is created: division by range of monthly per capita income level; In this way, it is observed how the possibility of demanding private health plans varies according to the race declared by the individuals associated with the level of income received in per capita terms by the Brazilian family consumption units, which reflects that with a per capita income monthly of 200 reais, regardless of the declared race, all individuals have the same probability of demanding a private health plan in Brazil. / Esta tesis esta compuesta por tres art?culos sobre Econom?a de la Salud. El primero documento busca analizar la posible integraci?n espacial de la red de hospitales p?blicos en Colombia, con el objetivo de analizar si existe eficiencia la momento de remitir los pacientes de acuerdo a el tipo de asistencia demandada en el hospital. A partir de la estimaci?n de un modelo de panel espacial, se analiz? la el total de hospitales que componen el sistema de oferta p?blica, concluyendo que a pesar de que puede existir cierto grado de transferencia en la atenci?n de pacientes es muy baja para el caso de medicina general, dado que el coeficiente espacial del modelo SDM, ? es inferior a uno. a vez realizado el an?lisis para el modelo est?tico se estimo el modelo din?mico SAR y SDM, se estimo un modelo din?mico que descompusiera los efectos en directos e indirectos, donde se evidencio que existe un efecto de distribuci?n espacial a largo plazo para la atenci?n de citas de medicina general determinado por el n?mero de personal asistencial de los 4 hospitales m?s cercanos sin embargo no se encontr? la presencia de transbordamientos en el corto plazo en la atenci?n de medicina general entre los hospitales de la red p?blica, dado que estas que estos se comportan como instituciones de prestaci?n de servicios b?sicos, sin disponer de un personal capacitado que permita una mejor atenci?n a partir del desarrollo de mejores practicas medicas. El mismo articulo calcula los modelos SDM,SAR,SAC para los hospitales de alta complejidad, teniendo como variable dependiente el n?mero de cirug?as practicadas con una matriz de distancia normalizada de 8 vecinos, concluyendo que el n?mero de urgencias atendidas por el hospital incide de manera negativa en el total de cirug?as practicadas, es decir, los hospitales de nivel alto de complejidad realizan en su mayor?a cirug?as programada, no obstante un cambio en el total de emergencias. con el prop?sito de controlar la existencia de efectos espaciales aleatorios en el errores se estimo el modelo GSPRE muestra que existe un efecto spillover que varia poco en el tiempo dado por el coeficiente ? = 0, 10 , que es estad?sticamente significativo pero peque?o, y que si existen shocks en el tiempo que modifican de manera significativa el comportamiento entre los hospitales. Este tipo de variaciones esta relacionado tal como lo manifiesta [21] con shocks tecnol?gicos, cambios en las instalaciones de los hospitales que permitan var?en de manera significativa la capacidad de realizar cirug?as. El segundo articulo analiza la descentralizaci?n en el sistema de salud, estudiando uno de los principales objetivos en la pol?tica p?blica: la prevenci?n de enfermedades, analizando la efectividad del programa en la realizaci?n de examenes citopatologicos preventivos en las mujeres, dada la disponibilidad de recursos en los equipos de atenci?n b?sica situados en todos los municipios de Brasil. A partir del an?lisis del programa Nacional de Melhoria do Acceso e da Qualidade de Aten??o B?sica ?PMAQ-, se hace un an?lisis factorial que calcula las covarianzas entre los insumos de personal, m?dicos y fisicos disponibles en los equipos, as? junto con caracter?sticas como la raza, ingresos, nivel de alfabetizaci?n, entre otras, la decisi?n de las mujeres de realizarse el examen citopatol?gico, se realiza un modelo que comprenda un sistema de ecuaciones estructurales. Se concluye as? que la descentralizaci?n se debe m?s all? que a un sistema conformado de manera correcta seg?n par?metros nacionales e internacionales, a una gesti?n de los bur?cratas, tal como se mostr?, en los estados donde hay d?ficit o un adecuado numero de puestos de salud, la estimaci?n tuvo coeficientes positivos, pero esto m?s all? del flujo de recursos, depende de la voluntad pol?tica de cada una de las esferas del gobierno para aumentar el numero de establecimientos de salud o de programas de salud. De est? manera, y en programas de salud familiar como la realizaci?n de examenes citopatologicos, se esta dando en la red de atenci?n b?sica en Brasil, dando cumplimiento al Pacto por la salud establecido para Brasil. Por ultimo se realiza el an?lisis de la demanda de planes de salud privados a partir de diferentes variables de caracterizaci?n individual, familiar, social, econ?mica y geogr?fica de los individuos y unidades de consumo familiar u hogares brasileros, a partir de un modelo logit. La permite determinar que los individuos de raza amarela, poseen la probabilidad m?s alta de elegir demandar un plan de salud privado en Brasil, espec?ficamente en las regiones Norte, Sur y Sureste del pa?s. De modo tal que en la regi?n sureste de Brasil, a un nivel de significancia del 1% la probabilidad de demandar un aseguramiento privado en salud es mayor para las personas de dicho color de piel o raza, se crea un control adicional: divisi?n por rango de nivel de renta per c?pita mensual; de esta manera se observa c?mo var?a la posibilidad de demandar planes de salud privados de acuerdo a la raza declarada por los individuos asociada al nivel de ingresos percibidos en t?rminos per c?pita por las unidades de consumo familiar brasileras lo cual refleja que con una renta per c?pita mensual de 200 reales, independientemente de la raza declarada, todos los individuos tienen la misma probabilidad de demandar un plan de salud privado en Brasil.