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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.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8065 |
| Date | 03 October 2017 |
| Creators | Pe?aloza, Anne Julissa Oduber |
| Contributors | Fran?a, Marco T?lio Aniceto |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Economia do Desenvolvimento, PUCRS, Brasil, Escola de Neg?cios |
| Source Sets | IBICT Brazilian ETDs |
| Language | Spanish |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -5405171042897922792, 500, 500, 500, 600, 944455694546435801, -2504903392600098822, 2075167498588264571 |
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