Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness

Simone Schenkman, Aylene Bousquat and Maria Paula Ferreira
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Simone Schenkman: School of Public Health, Sao Paulo University, Av. Dr. Arnaldo 715, Cerqueira César, Sao Paulo 01246-904, Brazil
Aylene Bousquat: School of Public Health, Sao Paulo University, Av. Dr. Arnaldo 715, Cerqueira César, Sao Paulo 01246-904, Brazil
Maria Paula Ferreira: School of Public Health, Sao Paulo University, Av. Dr. Arnaldo 715, Cerqueira César, Sao Paulo 01246-904, Brazil

IJERPH, 2022, vol. 19, issue 5, 1-22

Abstract: Health equity is cross sectioned by the reproduction of social relations of gender, ethnicity and power. The purpose of this article is to assess how intersectional health equity determines societal health levels, in a local efficiency analysis within Brazil’s Unified Health System (SUS), among Sao Paulo state municipalities. Fixed Panel Effects Model and Data Envelopment Analysis techniques were applied, according to resources, health production and intersectoral dimensions. The effect variables considered were expectation of life at birth and infant mortality rates, in 2000 and 2010, according to local health regions (HR) and regionalized healthcare networks (RRAS). Inequity was assessed both socioeconomically and culturally (income, education, ethnicity and gender). Both methods demonstrated that localities with higher inequities (income and education, gender and ethnicity oriented), associated or not to vulnerability (young and low-income families, in subnormal urban agglomerations), were the least efficient. Health production contributes too little to health levels, especially at the local level, which is highly correlated to the intersectoral dimension. Intersectional health equity, reinforced in its intertwining with ethnicity, gender and social position, is essential in order to achieve adequate societal health levels, beyond health access or sanitary and clinical efficacy.

Keywords: health equity; efficiency; intersectionality; Unified Health System; capitalism (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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