Determinants of outpatient expenditure within primary care in the Brazilian National Health System
Determinantes de gastos ambulatoriais na atenção primária do sistema público de saúde brasileiro
Keywords:
Health expenditures, Primary health care, Public health, Risk factors, EpidemiologyAbstract
CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP), Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests). Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01), hypertension (OR = 3.04; 95% CI: 1.91-4.82) and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81). Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47) and female sex (OR = 1.70; 95% CI: 1.14-2.55). CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.
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Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370(9603):1929-38.
Bahia L, Coutinho ES, Barufaldi LA, et al. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study. BMC Public Health. 2012;12:440.
Wolfenstetter SB. Future direct and indirect costs of obesity and the influence of gaining weight: results from the MONICA/KORA cohort studies, 1995-2005. Econ Hum Biol. 2012;10(2):127-38.
World Health Organization. WHO methods and data sources for country-level causes of death 2000-2012. Geneva, World Health Organization; 2014. Available from: http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_method_2000_2012.pdf?ua=1 Accessed in 2016 (Dec 26).
Puentes JD, Cahill J. Country report: The health care market in Brazil. PMLiVE. Available from: http://www.pmlive.com/pharma_intelligence/country_report_the_healthcare_market_in_brazil_409950 Accessed in 2016 (Dec 26).
Codogno JS, Turi BC, Kemper HC, et al. Physical inactivity of adults and 1-year health care expenditures in Brazil. Int J Public Health. 2015;60(3):309-16.
Turi BC, Codogno JS, Fernandes RA, et al. Accumulation of Domain-Specific Physical Inactivity and Presence of Hypertension in Brazilian Public Healthcare System. J Phys Act Health. 2015;12(11):1508-12.
Kilsztajn S, Silva DF, Camara MB, Ferreira VS. Grau de cobertura dos planos de saúde e distribuição regional do gasto público em saúde [Level of private health insurance coverage and regional distribution of public health expenditure]. Saúde Soc. 2001;10(2):35-45.
Zanuto EAC, Lima MCS, de Araújo RG, et al. Distúrbios do sono em adultos de uma cidade do Estado de São Paulo [Sleep disturbances in adults in a city of Sao Paulo state]. Rev Bras Epidemiol. 2015;18(1):42-53.
Zanuto EAC, Codogno JS, Christófaro DGD, et al. Prevalência de dor lombar e fatores associados entre adultos de cidade média brasileira [Prevalence of low back pain and associated factors in adults from a middle-size Brazilian city]. Ciên Saúde Coletiva. 2015;20(5):1575-82.
Fernandes RA, Zanesco A. Early sport practice is related to lower prevalence of cardiovascular and metabolic outcomes in adults independently of overweight and current physical activity. Medicina (Kaunas). 2015;51(6):336-42.
Schmidt MI, Duncan BB, Hoffmann JF, et al. Prevalência de diabetes e hipertensão no Brasil baseada em inquérito de morbidade auto-referida, Brasil, 2006 [Prevalence of diabetes and hypertension based on self-reported morbidity survey, Brazil, 2006]. Rev Saúde Pública. 2009;43(supl 2):74-82.
Meerding WJ, Bonneux L, Polder JJ, Koopmanschap MA, van der Maas PJ. Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study. BMJ. 1998;317(7151):111-5.
Codogno JS, Fernandes RA, Sarti FM, Freitas Júnior IF, Monteiro HL. The burden of physical activity on type 2 diabetes public healthcare expenditures among adults: a retrospective study. BMC Public Health. 2011;11:275.
Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign: Human Kinetics Books; 1988.
World Health Organization. Obesity: preventing and managing the Global Epidemic: Report of the WHO Consultation on Obesity. Geneva: World Health Organization: Geneva; 1997. Available from: http://www.who.int/nutrition/publications/obesity_executive_summary.pdf. Accessed in 2016 (Dec 26).
Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311(6998):158-61.
Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil; 2008. Available from: https://www.google.com.br/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjz2PGryOTPAhVDDZAKHXj8B0MQFggeMAA&url=http%3A%2F%2Fwww.abep.org%2FServicos%2FDownload.aspx%3Fid%3D07&usg=AFQjCNH2G9V5iYOmckiA4iLqDpCE1EYDsQ&sig2=gC9N3UnxmXEYRw9y9vHIrg Accessed in 2016 (Dec 26).
Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982;36(5):936-42.
Brandão AA, Rodrigues CIS, Consolim-Colombo F, et al. VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol. 2010;95(1 supl. 1):1-51.
Van Gaal LF, Mertens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444(7121):875-80.
Sichieri R, Nascimento S, Coutinho W. The burden of hospitalization due to overweight and obesity in Brazil. Cad Saúde Pública. 2007;23(7):1721-7.
de Oliveira ML, Santos LM, da Silva EN. Direct healthcare cost of obesity in Brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011. PLoS One. 2015;10(4):e0121160.
Atella V, Kopinska J, Medea G, et al. Excess body weight increases the burden of age-associated chronic diseases and their associated health care expenditures. Aging (Albany NY). 2015;(10): 882-92.
Li Q, Blume SW, Huang JC, Hammer M, Ganz ML. Prevalence and healthcare costs of obesity-related comorbidities: evidence from an electronic medical records system in the United States. J Med Econ. 2015;18(12):1020-8.
Davis JC, Verhagen E, Bryan S, et al. 2014 consensus statement from the first Economics of Physical Inactivity Consensus (EPIC) conference (Vancouver). Br J Sports Med. 2014;48(12):947-51.
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801-9.
Sui X, LaMonte MJ, Laditka JN, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA. 2007;298(21):2507-16.
Giudice R, Izzo R, Manzi MV, et al. Lifestyle-related risk factors, smoking status and cardiovascular disease. High Blood Press Cardiovasc Prev. 2012;19(2):85-92.
Janssen I. Health care costs of physical inactivity in Canadian adults. Appl Physiol Nutr Metab. 2012;37(4):803-6.
Méndez-Hernández P, Dosamantes-Carrasco D, Siani C, et al. Un programa de actividad física en el lugar de trabajo en una universidad pública de México puede reducir los costos médicos asociados a la diabetes tipo 2 e hipertensión [A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension]. Salud Pública Méx. 2012;54(1):20-7.
Codogno JS, Fernandes RA, Monteiro HL. Prática de atividades físicas e custo do tratamento ambulatorial de diabéticos tipo 2 atendidos em unidade básica de saúde [Physical activity and healthcare cost of type 2 diabetic patients seen at basic units of healthcare]. Arq Bras Endocrinol Metab. 2012;56(1):6-11.
Sarker AR, Mahumud RA, Sultana M, et al. The impact of age and sex on healthcare expenditure of households in Bangladesh. Springerplus. 2014;3:435.
Owens GM. Gender differences in health care expenditures, resource utilization, and quality of care. J Manag Care Pharm. 2008;14(3 Suppl):2-6.
