Economic crisis, austerity and its effects on the financing of oral health and access to public and private services

Rossi, Thais Regis Aranha; Lorena, José Eudes de; Chaves, Sonia Cristina Lima; Martelli, Petrônio José de Lima

doi:10.1590/1413-812320182412.25582019

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ARTICLE • Ciênc. saúde coletiva 24 (12) • Dec 2019 • https://doi.org/10.1590/1413-812320182412.25582019 copy

Economic crisis, austerity and its effects on the financing of oral health and access to public and private services

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study analyzed the effects of austerity and economic crisis on the financing of oral health, provision and use of public services and access to exclusively dental plans in Brazil, from 2003 to 2018. A retrospective, descriptive study was carried out, with a quantitative approach. Data were collected from the National Health Funding database, the National Supplementary Health Agency, the Strategic Management Support Room, and from the e-manager system. The federal fund-to-fund transfer was increasing from 2003 to 2010 and remained stable from 2011 to 2018. The supply decreased at the end of the period, with reduced coverage of the first programmatic dental appointment, average supervised tooth brushing and number of endodontic treatments. Against the background of the public financial crisis, exclusively dental plan companies expanded the market from 2.6 million users in 2000 to 24.3 million in 2018, with a profit of more than R$ 240 million. Fiscal austerity has a strong influence on the use of public dental services in Brazil, which can benefit the private market and widen inequalities.

Key words
Healthcare Financing; Health Policy; Oral Health

Year	OHT^* * Mod I + Mod II. Data related to December 2003 to 2017 and November/2018.	OHT population coverage (%)^ From 2003 to 2006 - SAGE/MS. From 2007 to 2018 DAB e-manager.	DSC	Total transfer Costing + Capital Values adjusted by IPCA	% Costing	% Capital	% PC	% SC
2003	6,170	20.5	-	R$ 191,549,053.10	100.00%	0	97.73%	2.27%
2004	8,951	26.6	100	R$ 434,927,702.00	98.47%	1.53%	95.33%	3.14%
2005	12,603	34.7	336	R$ 646,016,493.06	94.89%	5.11%	87.62%	7.27%
2006	15,086	39.8	498	R$ 834,576,989.52	96.94%	3.06%	85.43%	11.51%
2007	15,694	29.9	604	R$ 944,121,804.17	99.10%	0.90%	85.90%	13.20%
2008	17,807	33.3	674	R$ 966,406,637.19	99.14%	0.86%	86.22%	12.92%
2009	18,982	34.6	808	R$ 1,012,871,323.99	99.30%	0.70%	85.05%	14.25%
2010	20,424	36.5	853	R$ 1,082,757,666.35	99.96%	0.04%	87.94%	12.02%
2011	21,425	38.4	882	R$ 1,138,369,021.46	99.03%	0.97%	85.43%	13.59%
2012	22,203	38.9	944	R$ 1,290,637,679.59	99.39%	0.61%	86.01%	13.38%
2013	23,150	39.4	988	R$ 1,121,273,493.23	99.05%	0.95%	81.44%	17.61%
2014	24,323	39.8	1.030	R$ 1,158,100,496.56	99.65%	0.35%	78.79%	20.86%
2015	24,467	40.3	1.034	R$ 1,143,631,782.32	99.84%	0.16%	80.35%	19.49%
2016	24,384	39.9	1.072	R$ 1,169,899,916.68	99.77%	0.23%	80.51%	19.26%
2017	25,905	41.2	1.115	R$ 1,102,424,000.46	99.73%	0.27%	78.33%	21.40%
2018	26,807	42.2	1.139	R$ 541,746,947.93	72.16%	27.84%	72.16%	^* ***** Values not available in FNS. All values for 2018 are allocated to primary care or investments.

Year	Oral Health Teamsa	OHT population Coverage (%)^* * Mod I + Mod II. Data for December of each year. - Change of indicator for the period 2003-2007.	Absolute N. of first dental appointment	First dental appointment coverage (%)	Absolute N. of supervised dental brushing collective action	Supervised dental brushing collective action	Health Insurance Coverage rate^ Data provided by ANS.
2003	6,170	20.5	20,541,286	11.8	^* * Mod I + Mod II. Data for December of each year. - Change of indicator for the period 2003-2007.	-	2.30
2004	8,951	26.6	19,880,236	11.2	^* * Mod I + Mod II. Data for December of each year. - Change of indicator for the period 2003-2007.	-	2.90
2005	12,603	34.7	21,259,668	12.0	^* * Mod I + Mod II. Data for December of each year. - Change of indicator for the period 2003-2007.	-	3.30
2006	15,086	39.8	21,616,728	11.6	39,441,678	1.8	3.80
2007	15,694	29.9	21,905,348	11.6	52,897,566	2.3	4.60
2008	17,807	33.3	26,843,628	14.0	57,693,648	2.5	5.70
2009	18,982	34.6	27,156,753	14.0	60,304,340	2.6	6.70
2010	20,424	36.5	26,043,708	13.3	63,527,864	2.8	7.40
2011	21,425	38.4	29,449,468	14.9	62,504,333	2.7	8.00
2012	22,203	38.9	26,395,480	13.2	54,380,251	2.3	5.00
2013	23,150	39.4	29,526,595	14.7	53,246,037	2.2	9.90
2014	24,323	39.8	27,093,617	13.4	57,151,878	2.3	10.30
2015	24,467	40.3	29,925,575	14.6	50,543,350	2.1	10.80
2016	24,384	39.9	21,661,874	10.5	37,078,584	1.5	11.00
2017	25,905	41.2	17,263,772	8.3	29,556,598	1.2	11.60
2018	26,807	42.2	7,873,770	3.8	14,320,962	0.7	12.40

Year	Number of DSCs	Number of Endodontic Treatments	Number of Periodontal Procedures(per sextant - SIA/SUS codes: 0414020081, 0414020154, 0414020162, 0414020375)
Year	Number of DSCs	Number of Endodontic Treatments	Gingival graft	Gingivectomy and Gingivoplasty	Periodontal Surgical Treatment	Total
2008	674	527,474	22,646	287,918	92,766	403,330
2009	808	612,621	12,484	194,802	82,684	289,970
2010	853	681,057	7,054	191,439	88,871	287,364
2011	882	684,800	7,365	191,642	95,901	294,908
2012	944	691,933	10,859	193,156	105,807	309,822
2013	988	687,296	8,956	177,605	99,196	285,757
2014	1,030	683,265	5,155	177,518	147,064	329,737
2015	1034	682,181	5,230	203,788	168,631	377,649
2016	1072	635,923	3,877	189,740	180,837	374,454
2017	1,115	582,040	4,405	251,335	190,528	446,268
2018	1,139	495,005	4,139	133,747	159,427	297,313

Indicators	2003	2010	APC	95%CI	p	T	2011	2018	APC	95%CI	p	T
Total transfer (R$)	191,549,053	1,082,757,666	25.85	[7.69; 47.07]	0.000	I	1,138,369,021	541,746,948	-5.81	[-11.82; 0.61]	0.068	S
Total per capita transfer (R$)	1.10	5,65	24.04	[6.51; 44.47]	0.013	I	5.97	2.63	-6.26	[-12.50; 0.42]	0.061	S
Absolute N. of first dental appointments	20,541,286	26,043,708	4.91	[2.77; 7.11]	0.001	I	29,449,468	7,873,770	-15.42	[-27.94; -0.74]	0.043	D
Coverage first dental appointments (%)	11.76	13.59	3.41	[1.05; 5.82]	0.012	I	15.44	3.82	-16.10	[-28.97; -0.91]	0.042	D
Number of Endodontic Treatments	342,142	681,057	10.85	[9.32; 12.41]	0.000	I	684,800	495,005	-4.36	[-8.09; -0.48]	0.033	D
Total Periodontal Procedures	138,163	287,364	14.60	[6.01; 23.89]	0.005	I	294,908	297,313	5.27	[2.33; 8.29]	0.007	I
Health Plan Coverage Rate (%)	2.30	7.40	18.45	[17.17; 19.75]	0.000	I	8.00	12.40	10.34	[4.44; 16.57]	0.005	I

Year	Revenues (A) Absolute values	Revenues (A) Values adjusted by IPCA	Expenses (B) Absolute values	Expenses (B) Values adjusted by IPCA	A-B Absolute values	A-B Values adjusted by IPCA
2003	503,565,856.00	1,156,335,153.02	439,530,358.00	1,009,290,835.99	64,035,498.00	147,044,317,03
2004	598,981,305.00	1,282,603,220.65	497,748,152.00	1,065,831,900.76	101,233,153.00	216,771,319,89
2005	743,312,579.00	1,498,509,239.51	612,333,399.00	1,234,456,784.38	130,979,180.00	264,052,455,13
2006	910,346,220.00	1,781,471,629.67	742,074,189.00	1,452,177,298.89	168,272,031.00	329,294,330,78
2007	1,182,472,532.00	2,220,990,976.20	1,035,921,316.00	1,945,729,674.58	146,551,216.00	275,261,301,62
2008	1,272,309,260.00	2,246,235,788.96	1,126,812,499.00	1,989,364,254.65	145,496,761.00	256,871,534,31
2009	1,466,057,564.00	2,483,527,022.82	1,282,317,877.00	2,172,268,795.97	183,739,687.00	311,258,226,85
2010	1,805,512,742.00	2,895,401,661.70	1,579,923,053.00	2,533,635,862.32	225,589,689.00	361,765,799,38
2011	2,205,891,786.00	3,317,177,935.25	1,873,585,718.00	2,817,462,417.24	332,306,068.00	499,715,518,01
2012	2,454,271,223.00	3,497,152,422.43	2,088,620,779.00	2,976,127,963.52	365,650,444.00	521,024,458,91
2013	2,621,555,789.00	3,531,592,441.53	2,229,284,596.00	3,003,149,756.45	392,271,193.00	528,442,685,08
2014	2,874,714,484.00	3,634,381,934.00	2,465,543,769.00	3,117,084,420.53	409,170,715.00	517,297,513,47
2015	3,100,799,771.00	3,548,468,435.54	2,674,800,065.00	3,091,881,906.62	425,999,706.00	456,586,528,92
2016	3,210,551,952.00	3,434,108,784.47	2,825,008,074.00	3,021,718,753.71	385,543,878.00	412,390,030,76
2017	3,440,473,646.00	3,579,671,425.20	2,649,228,785.00	2,756,413,667.49	791,244,861.00	823,257,757,71
2018	1,626,332,953.00	1,626,332,953.00	1,386,264,999.00	1,386,264,999.00	240,067,954.00	240,067,954,00

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[1] Collaborations

TRA Rossi and JE Lorena-Sobrinho performed data collection, analysis, article writing and review. SCL Chaves and PJL Martelli analyzed the data, wrote the manuscript and revised its final version.