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      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

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          ABSTRACT

          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.

          RESUMO

          CONTEXTO E OBJETIVO:

          Um dos grandes desafios dos governos em todo o mundo é o financiamento de sistemas de saúde e, por isso, é necessário compreender fatores e componentes-chave associados a despesas em saúde. O objetivo foi identificar fatores demográficos, socioeconômicos, de estilo de vida e clínicos associados aos gastos diretos com saúde na atenção primária entre adultos do Sistema Único de Saúde da cidade de Bauru.

          TIPO DE ESTUDO E LOCAL:

          Estudo transversal realizado em cinco Unidades Básicas de Saúde em Bauru (SP), Brasil.

          MÉTODO:

          Gastos com saúde nos últimos 12 meses foram avaliados através de prontuários médicos de adultos de 50 anos ou mais. Gastos anuais com saúde foram avaliados com: medicamentos, exames laboratoriais, consultas médicas e total. Índice de massa corporal, circunferência da cintura, hipertensão, idade, sexo, atividade física e tabagismo foram avaliados por meio de entrevista face a face.

          RESULTADOS:

          O gasto total com serviços de saúde para os 963 participantes deste inquérito foi de US$ 112.849.74 (46,9% consultas, 35,2% medicamentos e 17,9% exames). Gastos com medicamentos foram associados com sobrepeso ( odds ratio, OR = 1,80 [intervalo de confiança, IC 95%: 1,07-3,01]), hipertensão (OR = 3,04 [IC 95%: 1,91-4,82]) e atividade física moderada (OR = 0,56 [95% IC: 0,38-0,81]). Gastos com consultas foram associados com hipertensão (OR = 1,67 [IC 95%: 1,12-2,47]) e sexo feminino (OR = 1,70 [IC 95%: 1,14-2,55]).

          CONCLUSÃO:

          Nossos resultados mostraram que sobrepeso, menor nível de atividade física e hipertensão são fatores de risco independentes associados com maiores gastos com saúde na atenção primária.

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          Most cited references46

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          Health benefits of physical activity: the evidence.

          The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.
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            Mechanisms linking obesity with cardiovascular disease.

            Obesity increases the risk of cardiovascular disease and premature death. Adipose tissue releases a large number of bioactive mediators that influence not only body weight homeostasis but also insulin resistance - the core feature of type 2 diabetes - as well as alterations in lipids, blood pressure, coagulation, fibrinolysis and inflammation, leading to endothelial dysfunction and atherosclerosis. We are now beginning to understand the underlying mechanisms as well as the ways in which smoking and dyslipidaemia increase, and physical activity attenuates, the adverse effects of obesity on cardiovascular health.
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              A short questionnaire for the measurement of habitual physical activity in epidemiological studies.

              The construct validity and the test-retest reliability of a self-administered questionnaire about habitual physical activity were investigated in young males (n = 139) and females (n = 167) in three age groups (20 to 22, 25 to 27, and 30 to 32 yr) in a Dutch population. By principal components analysis three conceptually meaningful factors were distinguished. They were interpreted as: 1) physical activity at work; 2) sport during leisure time; and 3) physical activity during leisure time excluding sport. Test-retest showed that the reliability of the three indices constructed from these factors was adequate. Further, it was found that level of education was inversely related to the work index, and positively related to the leisure-time index in both sexes. The subjective experience of work load was not related to the work index, but was inversely related to the sport index, and the leisure-time index in both sexes. The lean body mass was positively related the the work index, and the sport index in males, but was not related to the leisure-time index in either sex. These differences in the relationships support the subdivision of habitual physical activity into the three components mentioned above.
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                Author and article information

                Journal
                Sao Paulo Med J
                Sao Paulo Med J
                Sao Paulo Med J
                São Paulo Medical Journal
                Associação Paulista de Medicina - APM
                1516-3180
                1806-9460
                03 April 2017
                2017
                : 135
                : 3
                : 205-212
                Affiliations
                [I ] originalMSc, PhD. Researcher, Postgraduate Program on Kinesiology, Universidade Estadual Paulista (UNESP), Rio Claro (SP), Brazil.
                [II ] originalMSc, PhD. Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
                [III ] originalMSc, PhD. Professor, Department of Food and Experimental Nutrition, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
                [IV ] originalPhD. Senior Research Fellow. Institute of Environment, Health and Societies, Brunel University, Uxbridge, London, United Kingdom.
                [V ] originalMSc, PhD. Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil.
                Author notes
                Address for correspondence: Bruna Camilo Turi. Rua Roberto Simonsen, 305, Presidente Prudente (SP) - Brasil. CEP 19060-900. Tel. (+55 18) 3229-5712. Fax. (+55 18) 3221-4391. E-mail: brunacturi@ 123456gmail.com

                Conflict of interest: None

                Article
                10.1590/1516-3180.2016.0224141116
                10019845
                28380203
                1d96ee07-47db-470d-96d1-b429e6d6d18b
                © 2022 by Associação Paulista de Medicina

                This is an open access article distributed under the terms of the Creative Commons license.

                History
                : 02 November 2016
                : 14 November 2016
                Page count
                Figures: 4, Tables: 0, Equations: 0, References: 34, Pages: 08
                Categories
                Original Article

                health expenditures,primary health care,public health,risk factors,epidemiology

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