Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic.Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi* was performed to identify areas lacking access to high-complexity centers (HCC).Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs.Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.

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The future of emergency medicine in Canada: submission from CAEP to the Romanow Commission. Part 1

CJEM ◽

10.1017/s1481803500007788 ◽

2002 ◽

Vol 4 (05) ◽

pp. 359-368 ◽

Cited By ~ 7

Author(s):

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Health Care System ◽

Emergency Care ◽

Care Delivery ◽

Prehospital Care ◽

Public Health Care ◽

Canadian Association ◽

The Future ◽

Care System

ABSTRACT: In April 2001, the Commission on the Future of Health Care in Canada was established. The Honorable Roy Romanow was given the mandate to “inquire into and undertake dialogue with Canadians on the future of Canada’s public health care system” and “to develop recommendations that will ensure the long-term sustainability of a high quality, universally accessible, publicly administered health care system, for all Canadians.” The Canadian Association of Emergency Physicians (CAEP) recognized an obligation to share in this public dialogue, to communicate the current state of emergency medicine, and to identify the components necessary to achieve excellence in emergency care. The CAEP Advocacy Committee was asked to develop a document that would educate and enlighten the Commissioner. Basic themes were identified, and authors from across the country were invited to write brief, factual essays with achievable recommendations. The resulting series of essays was presented on April 30, 2002, at the Health Care Commission’s open public hearing in Calgary, Alberta. This article, part 1 of a 2-part series, includes discussions of Urban Emergency Care Delivery, Rural Emergency Care, Emergency Care for Children, Prehospital Care and Emergency Medical Services, and National Standards for Hospital Emergency Services.

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Contribution of the Unified Health Care System to mammography screening in Brazil, 2013

Radiologia Brasileira ◽

10.1590/0100-3984.2014.0129 ◽

2016 ◽

Vol 49 (5) ◽

pp. 305-310 ◽

Cited By ~ 9

Author(s):

Ruffo Freitas-Junior ◽

Danielle Cristina Netto Rodrigues ◽

Rosangela da Silveira Corrêa ◽

João Emílio Peixoto ◽

Humberto Vinícius Carrijo Guimarães de Oliveira ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Mammography Screening ◽

Federal District ◽

Target Population ◽

Northern Region ◽

The State ◽

Expected Number ◽

The North ◽

Care System

Abstract Objective: To estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System), at the state and regional level, in 2013. Materials and Methods: This was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute. Results: In 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Pará and highest in the state of Santa Catarina (7.5% and 35.7%, respectively). Conclusion: The coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasília) and among regions, being higher in the south/southeast and lower in the north/northeast.

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An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211021551 ◽

2021 ◽

pp. 194173812110215

Author(s):

Gillian R. Currie ◽

Raymond Lee ◽

Amanda M. Black ◽

Luz Palacios-Derflingher ◽

Brent E. Hagel ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Policy Change ◽

National Policy ◽

Ice Hockey ◽

Public Health Care ◽

Public Health Care System ◽

Body Checking ◽

Care System

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

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