The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil
Introduction Although economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhão and São Paulo, two unevenly developed states in Brazil, to explore the health financing and system...
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BMJ Publishing Group
2020-03-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/5/2/e002122.full |
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| author | Giuliano Russo Lucas Salvador Andrietta Maria Luiza Levi Mário C Scheffer Maria Teresa Seabra Soares de Britto e Alves Bruno Luciano Carneiro Alves de Oliveira |
| author_facet | Giuliano Russo Lucas Salvador Andrietta Maria Luiza Levi Mário C Scheffer Maria Teresa Seabra Soares de Britto e Alves Bruno Luciano Carneiro Alves de Oliveira |
| author_sort | Giuliano Russo |
| collection | DOAJ |
| description | Introduction Although economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhão and São Paulo, two unevenly developed states in Brazil, to explore the health financing and system performance changes brought in by its 2014–2015 economic recession.Methods Drawing from economic and health system research literature, we designed a conceptual framework exploring the links between macroeconomic factors, labour markets, demand and supply of health services and system performance. We used data from the National Health Accounts and National Household Sample Survey to examine changes in Brazil’s health spending over the 2010–2018 period. Data from the National Agency of Supplementary Health database and the public health budget information system were employed to compare and contrast health financing and system performance of São Paulo and Maranhão.Results Our analysis shows that Brazil’s macroeconomic conditions deteriorated across the board after 2015–2016, with São Paulo’s economy experiencing a wider setback than Maranhão’s. We showed how public health expenditures flattened, while private health insurance expenditures increased due to the recession. Public financing patterns differed across the two states, as health funding in Maranhão continued to grow after the crisis years, as it was propped up by transfers to local governments. While public sector staff and beds per capita in Maranhão were not affected by the crisis, a decrease in public physicians was observed in São Paulo.Conclusion Our case study suggests that in a complex heterogeneous system, economic recessions reverberate unequally across its parts, as the effects are mediated by private spending, structure of the market and adjustments in public financing. Policies aimed at mitigating the effects of recessions in LMICs will need to take such differences into account. |
| format | Article |
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| issn | 2059-7908 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-bd1af497bbe745dfad3dd9415fe3542b2025-08-20T02:09:28ZengBMJ Publishing GroupBMJ Global Health2059-79082020-03-015210.1136/bmjgh-2019-002122The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in BrazilGiuliano Russo0Lucas Salvador Andrietta1Maria Luiza Levi2Mário C Scheffer3Maria Teresa Seabra Soares de Britto e Alves4Bruno Luciano Carneiro Alves de Oliveira5Centre for Primary Care and Public Health, Queen Mary University of London, London, United KingdomDepartamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, BrazilCentro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Santo Andre, São Paulo, BrazilDepartamento de Medicina Preventiva, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, São Paulo, BrazilDepartamento de Saúde Pública, Universidade Federal do Maranhão, Sao Luis, Maranhão, BrazilDepartamento de Saúde Pública, Universidade Federal do Maranhão, Sao Luis, Maranhão, BrazilIntroduction Although economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhão and São Paulo, two unevenly developed states in Brazil, to explore the health financing and system performance changes brought in by its 2014–2015 economic recession.Methods Drawing from economic and health system research literature, we designed a conceptual framework exploring the links between macroeconomic factors, labour markets, demand and supply of health services and system performance. We used data from the National Health Accounts and National Household Sample Survey to examine changes in Brazil’s health spending over the 2010–2018 period. Data from the National Agency of Supplementary Health database and the public health budget information system were employed to compare and contrast health financing and system performance of São Paulo and Maranhão.Results Our analysis shows that Brazil’s macroeconomic conditions deteriorated across the board after 2015–2016, with São Paulo’s economy experiencing a wider setback than Maranhão’s. We showed how public health expenditures flattened, while private health insurance expenditures increased due to the recession. Public financing patterns differed across the two states, as health funding in Maranhão continued to grow after the crisis years, as it was propped up by transfers to local governments. While public sector staff and beds per capita in Maranhão were not affected by the crisis, a decrease in public physicians was observed in São Paulo.Conclusion Our case study suggests that in a complex heterogeneous system, economic recessions reverberate unequally across its parts, as the effects are mediated by private spending, structure of the market and adjustments in public financing. Policies aimed at mitigating the effects of recessions in LMICs will need to take such differences into account.https://gh.bmj.com/content/5/2/e002122.full |
| spellingShingle | Giuliano Russo Lucas Salvador Andrietta Maria Luiza Levi Mário C Scheffer Maria Teresa Seabra Soares de Britto e Alves Bruno Luciano Carneiro Alves de Oliveira The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil BMJ Global Health |
| title | The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil |
| title_full | The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil |
| title_fullStr | The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil |
| title_full_unstemmed | The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil |
| title_short | The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil |
| title_sort | differential impact of economic recessions on health systems in middle income settings a comparative case study of unequal states in brazil |
| url | https://gh.bmj.com/content/5/2/e002122.full |
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