Surgery in Brazilian Health Care: funding and physician distribution

• Published in: Revista do Colégio Brasileiro de Cirurgiões 2017-04, Vol.44 (2), p.202-207
• Main Authors: ALONSO, NIVALDO, MASSENBURG, BENJAMIN B., GALLI, RAFAEL, SOBRADO, LUCAS, BIROLINI, DARIO
• Format: Article
• Language: eng ; por
• Subjects: General Surgery. Public Health Administration. Public Policy. Surgery Department; Hospital. Medically Underserved Area
• ISSN: 0100-6991; 1809-4546; 1809-4546
• DOI: 10.1590/0100-69912017002016

ABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce. RESUMO Objetivo: analisar dados demográficos do Sistema Único de Saúde (SUS) brasileiro, que promove cobertura de saúde universal a toda população, e discutir os problemas revelados, com particular ênfase nos cuidados cirúrgicos. Métodos: os dados foram obtidos a partir dos bancos de dados de saúde pública da Demografia Médica, do Conselho Federal de Medicina, do Instituto Brasileiro de Geografia e Estatística e do Cadastro Nacional dos Estabelecimentos de Saúde. A densidade e a distribuição do trabalho médico e dos estabelecimentos de saúde foram avaliadas, e as regiões geográficas foram analisadas usando o índice de desigualdade público-privado (IDPP). Resultados: o Brasil tem, em média, dois médicos por 1000 habitantes, que são desigualmente distribuídos no país. Tem 22.276 cirurgiões gerais certificados (11,49 por 100.000 habitantes). Existem no país 257 escolas de medicina, com 25.159 vagas por ano, e apena