Research Department

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Research Department National Accounts Coordination
Health and education volume output in Brazil
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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 Services.
• 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 80s.

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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.

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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 administrations expenditure on
  private health services amounted to R 10,0
  billion, 14,9 of the overall expenditure on
  private health services.

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The Brazilian education system

• In 2005, final consumption of private education
  services amounted to 1,7 of the countrys 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).

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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.

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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.

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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.

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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.

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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.

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Volume indexes private health

• Value Value data for the three private health
  items come from the enterprises Income Tax
  information.

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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.

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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 groups
  data variance throughout time before adopting
  this more elaborate volume index.

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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.

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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.

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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
  educations output value.

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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.

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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.

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Conclusions

• Present refinements in information systems for
  private and public health and for public
  education, however, offer hopes of change in
  the future.

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Ricardo Montes de Moraes National Accounts
Coordination Brazilian Institute of Geography and
Statistics (IBGE). e-mail ricardo.moraes_at_ibge.go
v.br.