Research Department
National Accounts
Coordination
Health and education
volume output in Brazil
Data 14/10/08
The Brazilian health system
• Since 1988, Brazilian government provides
tax-financed universal healthcare coverage to
its citizens, with no eligibility restrictions – on
principles inspired in the British National Health
Service´s.
• Although there are no eligibility restrictions in
the public health system, private health services
may have increased their market share in health
services’ value final consumption since the 80’s.
The Brazilian health system
• This is due to the growing importance of
private health insurance, through which private
health may offer higher-quality services and
lower waiting times than the public system.
• In 2005, final consumption of health-related
goods and services amounted to 8,0% of
Brazilian GDP.
• This includes expenditure on prescription
drugs, private health insurance and medical
devices and consumables.
The Brazilian health system
• Government expenditure on these goods and
services amounted to 3,1% of Brazilian GDP.
• Part of the private health production is offered
free of charge to the population – and paid for
by the government.
• In 2005, public administration’s expenditure on
private health services amounted to R$ 10,0
billion, 14,9% of the overall expenditure on
private health services.
The Brazilian education system
• In 2005, final consumption of private
education services amounted to 1,7% of the
country’s GDP. Consumption of public education
amounted to 3,2%.
• In the public sector, municipalities are
responsible for providing basic education, states
for the intermediate level and the federal
government for the superior one (although there
are state universities as well).
Volume indexes: public health
• Volume: Weighted averages of changes in
inpatient days and outpatient procedures.
Source: SUS’ Informatics Department
(DATASUS).
• Value: State and municipal government
balance sheets and other administrative
databases.
Volume indexes: private health
• Volume: Up to now, the main indexes used for
private health are the total number of inpatient
days and outpatient procedures bought by SUS
from private health service providers, released
by DATASUS.
• In 2008, the Brazilian Institute of Geography
and Statistics (IBGE) started receiving data
from the National Supplementary Health Agency
(ANS), the agency that regulates market
activity of private health insurance providers in
Brazil.
Volume indexes: private health
• Created in 2000, ANS generates reports on
health plans’ expenditures on health services –
inpatient and outpatient care.
• Health insurance providers are responsible for
more than half of all expenses on private health
services consumption in Brazil.
• IBGE is currently studying the best ways to
organize these data and solve scope change
problems. After this, it might be possible to deflate
and use these data as volume indicators.
Volume indexes: private health
• Brazilian National Accounts divides private
health into three activities:
• Inpatient care (hospital services)
• Other health services (ambulatory services)
• Private social services
• For the first two items, volume is given by
inpatient days and number of outpatient
procedures.
Volume indexes: private health
• For the third one, which includes asylums,
rehabilitation clinics etc., volume is obtained
through deflation, using a price index that
reflects the activities’ costs (intermediate
consumption).
• This third item represents less than 4% of the
private health services production.
Volume indexes: private health
• Value: Value data for the three private health
items come from the enterprises Income Tax
information.
Problems and perspectives
• In January 2008, SUS revised and unified its
standard health procedures list, which
establishes prospective payment rates for
payment to health service providers and now
comprises 2.311 procedures.
• The new standard health procedures list
introduced some refinements related to
disease reporting and their relation to specific
procedures.
Problems and perspectives
• Procedures can eventually be aggregated by
large diagnoses groups (according to the
International Classification of Diseases - ICD)
and then weighted by their average costs in a
single volume index.
• It will be necessary to analyze each group’s
data variance throughout time before adopting
this more elaborate volume index.
Problems and perspectives
• The recent change in the procedures list led to
significant discontinuities in data reports. But, in
the future, it may allow for better quality in
output volume indexes.
Volume indexes: public education
• Volume: Change in the number of students
enrolled at public schools and universities,
weighted by the average cost per student in
each educational level.
• The levels used are: preschool, primary and
secondary school, high school, complementary
(supletivo), college and special education
school.
• Source: Annual School Census, Education
Ministry.
Volume indexes: public education
• Value: The administrative records used are
similar to those used in public health.
• Federal government is working on an
information system that might - in the future centralize data on education public expenditure,
allowing for refinements in the measurement of
public education’s output value.
Volume indexes: private education
• Volume: Change in the number of students
enrolled at private schools according to the
Annual School Census.
• Value: Enterprises income declarations.
Conclusions
• Brazil shares with other countries the usual
difficulties in devising quality adjusted output
indexes.
• Health and education volume indexes still do
not capture the effects of quality changes in
the output of these services, relying on
quantitative information on inpatient days,
number of outpatient health procedures and
number of enrolled students.
Conclusions
• Present refinements in information systems
for private and public health and for public
education, however, offer hopes of change in
the future.
Ricardo Montes de Moraes
National Accounts Coordination
Brazilian Institute of Geography and Statistics (IBGE).
e-mail: ricardo.moraes@ibge.gov.br.