Spatially balanced provision of health equipment: a cross-sectional study oriented to the identification of challenges to access promotion

Abstract

BackgroundAccess to health services is in part defined by the spatial distribution of healthcare equipment. To ensure equity in the provision of health services, it is important to examine availability across different health care providers taking into account population demand. Given the importance of the equitable provision of health equipment, we evaluate its spatial distribution in Brazil.MethodsThis study is classified as cross-sectional with an ecological design. We evaluate Brazilian data on distance to available health equipment considering: dialysis machines (385), magnetic resonance imaging (MRI) (257), hospital beds (3675) and bone densitometers (429). We define two distance thresholds (50 km and 200 km) from a municipality to the center of services provision. The balance between infrastructure capacity and potential demand was evaluated to identify a lack or surplus of health services.ResultsThe distribution of dialysis equipment and bone densitometers is not balanced across Brazilian states, and unmet demand is high. With respect to MRIs, the large capacity of this equipment results in a large excess of supply. However, this characteristic alone cannot account for excesses of supply of over 700%, as is the case of the Federal District when the range is limited to 50 km. At the same time, four states in the Northeastern region of Brazil show a net excess of demand. Some regions do not meet the standard amount of supply defined by Brazilian Ministry of Health. The quantity and distribution of hospital beds are not sufficient to provide full coverage to the population.ConclusionOur main focus was to evaluate the network of the provision of health equipment in Brazil, considering both private and public sectors conjointly. We take into account two main aspects of a spatially balanced health system: the regional availability of health equipment and the geographic distance between its demand and supply at the municipality level. Some regions do not meet the minimum requirement defined by the Brazilian Ministry of Health regarding the supply of health services.

Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data

“…There is substantial heterogeneity between its five macroregions (North, Northeast, Central-West, Southeast, and South), including socioeconomic heterogeneity, which is reflected in the quality of regional health services, including the availability of hospital beds and trained health-care workers. 1 , 2 , 3 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to Brazil via international flights, and COVID-19 cases were initially concentrated in the large metropolitan areas, spreading from state capitals to the towns. 4 …”

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach

“…This study aims to present estimates of geographic accessibility to COVID-19 healthcare at a high spatial resolution within Brazil's 20 largest cities. Healthcare services in Brazil are known to be unevenly distributed across the country and also within cities ( Amaral et al, 2017 ). In this context, it is crucial to map where vulnerable social groups confront poor accessibility to health services.…”

Estrutura espacial e provisão de atenção primária à saúde nos municípios brasileiros

“…Nesse contexto, a distribuição espacial da oferta de serviços de saúde é de suma importância porque impacta, diretamente, a distância coberta pelo paciente para efetivar seu acesso. Stock (1983), Dranove, William e Wu (1993), Goodman et al (1997), Oliveira, Travassos e Carvalho (2004 e Amaral et al (2017), dentre outros, destacam a importância da distância, e, por consequência, do tempo de deslocamento, na utilização de serviços de saúde. Logo, a distância percorrida e o tempo gasto podem se tornar uma barreira de acesso significativa, capaz de causar impacto na qualidade de vida da população e até de pôr em risco a vida de um paciente em situação mais complexa.…”

“…Essa característica, aliada ao fato de profissionais de saúde geralmente preferirem habitar centros urbanos e áreas mais desenvolvidas (KUHN; OCHSEN, 2009; PÓVOA, ANDRADE; MORO, 2004), resulta na tendência de concentração de serviços de saúde em torno de aglomerados urbanos. Como consequência, sua presença é escassa em áreas relativamente menos desenvolvidas e rurais (AMARAL et al, 2017;ROCHA et al, 2017). Uma vez que a condição de saúde é associada ao status socioeconômico (NORONHA, 2001) e a estrutura espacial da oferta de serviços de saúde impacta suas taxas de utilização (HIGGS, 2009), essa concentração é perversa no sentido de que a provisão de serviços de saúde é escassa em locais onde seria mais necessária: a chamada "inverse care law" (HART, 1971 A criação do SUS foi o reconhecimento, pela população brasileira, de que o acesso equitativo e igualitário à saúde é um direito fundamental.…”