determinantes dos gastos com diálises no sistema Único de saúde, brasil, 2000 a 2004 determinants of expenditures on dialysis in the unified national health system, brazil, 2000 to 2004

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ID: 187879
2010
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Abstract
O objetivo deste estudo é comparar os gastos ambulatoriais totais entre hemodiálise e diálise peritoneal, de 2000 a 2004, dos pacientes que iniciaram diálise, em 2000, no Sistema Único de Saúde (SUS). Foi desenvolvida coorte histórica de pacientes que iniciaram diálise em 2000, identificados por pareamento probabilístico na base de dados de Autorização de Procedimentos de Alta Complexidade/Custo (APAC). Utilizou-se modelo de regressão linear múltipla incluindo atributos individuais, clínicos e variáveis de oferta de serviços de saúde. A coorte foi constituída por 10.899 pacientes, 88,5% iniciaram em hemodiálise, e 11,5%, em diálise peritoneal. A modalidade explica 12% da variância dos gastos, os pacientes em diálise peritoneal apresentam um gasto médio anual 20% maior. Os diferenciais nos gastos são explicados pelo estado da federação e nível de oferta de serviços de saúde. As variáveis de risco individual não alteram o poder de explicação do modelo, sendo significativos a idade e a presença de diabetes mellitus. Constata-se a importância do sistema de pagamento do SUS para explicar as diferenças de gastos do tratamento dialítico no Brasil.
The aim of this study was to compare total outpatient expenditures on hemodialysis and peritoneal dialysis from 2000 to 2004 in patients that began dialysis in 2000 under the Unified National Health System (SUS). A historical cohort was developed, consisting of patients that began dialysis in 2000, identified by probabilistic matching in the database of Authorizations for High-Complexity/High-Cost Procedures (APAC). A multiple linear regression model was used, including individual and clinical attributes and health services supply variables. The cohort included 10,899 patients, 88.5% of whom began hemodialysis and 11.5% peritoneal dialysis. The dialysis modality explains 12% of the variance in expenditures, and patients in peritoneal dialysis showed 20% higher mean annual expenditure. The differences in expenditures are explained according to the State of Brazil and health services supply level. Individual risk variables did not alter the model's explanatory power, while age and diabetes mellitus were significant. The study showed the importance of the National Health System's payment mechanism for explaining differences in expenditures on dialysis treatment in Brazil.
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Authors ;Mariangela Leal Cherchiglia;Isabel Cristina Gomes;Juliana Alvares;Augusto Guerra Júnior;Francisco de Assis Acúrcio;Eli Iola Gurgel Andrade;Alessandra Maciel Almeida;Daniele Araújo Campo Szuster;Mônica Viegas Andrade;Odilon Vanni de Queiroz
Journal iberian conference on information systems and technologies, cisti
Year 2010
DOI
10.1590/S0102-311X2010000800016
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2010000800016
Keywords
dialysis health expenditures renal insufficiency

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