In 2005, health-related activities generated R$ 97.3 billion, and public health accounted for 33.4% of this figure.

 

In 2005, health-related activities generated R$ 97.3 billion, and public health accounted for 33.4% of this figure. Although the participation of the value generated by these activities in the total value generated faced slight decrease between 2000 (5.7%) and 2005 (5.3%), they have had repeated real growth rates in this period, having reached 5.9% in the last year of the series. In 2005, health activities accounted for 3.9 million jobs (4.3% of the total in the country), being most of them (2.6 million) with a formal employment, paying average annual income of R$ 15.9 thousand. Brazilian families accounted, in 2005, for 60.2% of the total expenses with health-related goods and services, being the most significant expenses those related to: medical appointments, medical services in general and medicines.

 

These are some of the details presented in the study of resources and uses of health in Brazil, called “Health Economics:  a Macroeconomic Perspective – 200-2005. The publication is the result of the cooperative work performed by IBGE, the Ministry of Health, Oswaldo Cruz Foundation,  the Institute of Research in Applied Economics (IPEA) and the Regulatory Agency of Supplementary Health Programs (ANS) in the process of elaboration of health satellite-accounts.  

 

In 2005, health-related activities¹ generated value added (VA)² of R$ 97.3 billion, which represented 5.3% of the total VA of Brazilian economy (about R$ 1.8 trillion). That year’s participation in the total value added was below that of 2000 (5.7%), and remained at about 5.5% throughout the series (2000-2005), as seen in the table below.

 

 

 

The highest percentage of value added of health-related activities, in 2005, was that of public healthcare³ (33.4% or R$ 32.5 billion), followed by other health-related activities⁴ (20.4% or R$ 19.9 billion) and by production of pharmaceutical products (13.3% or R$ 13 billion).

 

 

 

Health activities increased 5.9% between 2004 and 2005

 

Despite the significant loss of participation of value added in the total of economy, between 2000 and 2005 (from 5.7% to 5.3%), the volume⁵ of value added of health-related activities increased in all the years of the period analyzed. In 2001, there was 4.1% of increase; in 2002, 1.8%; in 2003,  0.9%; in 2004, 3.0%; and, in 2005, 5.9%.

 

Pharmaceutical industry, after a period of retrogression between 2001 and 2003, increased once again in 2004 (3.5%), and had significant increase in 2005 (12.6%). Trade of pharmaceutical, medical, orthopedic and odontological problems followed the same path and Hospital assistance services had, in a single year, increase above that of health economics (2001, with 4.2%).

 

Between 2004 and 2005, there was acceleration of increase in the following activities: public healthcare (from 0.0% to 4.1%); other health-related activities (from 5.7% to 7.6%), trade of pharmaceutical products (from 5.7% to 12.2%) and production of pharmaceutical products (from 3.5% to 12.6%).

 

Families accounted for 60.2% of the expenses with consumption of goods and services

 

The final consumption expenditure with health goods and services⁶ in 2005 was R$ 171.6 billion (8.0% of the GDP). From this total, families spent R$ 103.2 billion (4.8% of the GDP), and public administration spent R$ 66.6 billion (3.1%) and non-profit institutions at family service (ISFL), R$ 1.8 billion (0.1%). These participations changed little throughout the series (2000-2005): the expenditure of families represented, on average, 4.9% of the GDP in this period; government expenditure represented 3.2% of the GDP and the expenditure of non-profit institutions, 0.1% of the GDP.

 

In relation to the total expenses related to health, public administration accounted, in 2005, for 38.8%, whereas families accounted for 60.2% and non-profit institutions at family service, for 1.0%.

 

Throughout the time series (2000-2005), the main figure of final consumption expenditure was that of Other health-related activities (average of 1.8% of the GDP), which includes appointments and exams, mainly those produced in the ambulatory field. Medicines (average of 1.6% of the GDP between 2000 and 2005) also played a significant role in the expenditure of families.

 

Public healthcare is the main expenditure of final consumption of public administration (which changed from 2.4% to 2.6%, between 2000 and 2005). Public administration also has expenses with Hospital assistance services and Other health-related activities – market services which the government acquires in order to offer freely to families. Between 2000 and 2005, government expenditure with these health market services fell as a percentage of GDP, reaching, in 2005, 0.5% of the GDP.

 

These data are summarized in the table below:

 

 

 

Imports are more important in the pharmaceutical subsector

 

Imports of health-related goods and services reached R$ 10.0 billion in 2005, equivalent to 5.0% of the total offer of these goods and services in the country and to 4.0% of the total Brazilian exports. The exports of health-related goods and services reached R$ 1.9 billion, or 0.6% of the total Brazilian exports in 2005.

 

The participation of imports in the total offer of health-related activities is specifically high for pharmaceutical products – inputs used in the production of medicines. In 2003, imported products made up 93.9% of the supply of pharmaceutical products in the Brazilian market; this proportion fell to 83.2% in 2005.

 

Since 2002, almost all the health industrial products have faced, in percentage terms, decrease of participation of imports in the total supply.

 

In 2005, health-related activities generated 3.9 million jobs

 

Health-related activities accounted, in 2005, for 3.9 million jobs in the country. This represented 4.3% of the 90.9 million jobs in the country. The number of jobs is not the same as that of employed persons, since a person may have more than one job position – for example, some doctors work in more than one hospital.

 

From 2000 to 2005, health activities were directly responsible for over 4% of the total jobs⁷ in the country. There was slight proportional increase according to the number of health-related jobs in relation to other economic activities, and health-related jobs changed from 4.1% of the total occupation in 2000 to 4.3% in 2005.

 

 

The two sectors with the biggest number of jobs are also the ones with the highest value added: Public healthcare (1.3 million job positions) and Other health-related activities (1.0%). The third activity with the biggest number of occupations is Trade of pharmaceutical, medical, orthopedic and odontological products (681 thousand).

 

Hospital assistance services (private ones) had the lowest proportional increase in the number of jobs among health-related activities. On the other hand, in Other health-related activities were created more than 200 thousand new jobs, with increase of 26.0% in the period 2000-2005.

 

Annual average income reached R$ 15.9 thousand in 2005

 

In 2005, the average yield of workers in health-related activities was R$ 15.9 thousand, considering salaries and mixed income⁸. The activities with the highest income by occupation were Production of pharmaceutical products (R$ 36.3 thousand) and Hospital assistance services (health insurance, with R$ 23.8 thousand). The average yield of production of pharmaceutical products was about 3.6 times above the average of economy in the period 2000-2005. The income of this activity increased less than that of the average of economy in 2003 and in 2004, but above average in 2005. 

 

The table below shows the average income from work in the economy and in the health subsector – in current values for each year. It is important to highlight that this average income concerns all the workers employed in the activity, and not specific professional categories.

 

 

In 2005, the number of formal jobs reached 2.6 million

 

In 2005, among the 3.9 jobs in health-related activities, 2.6 million had a formal contract, 690 thousand did not have a formal contract and 611 thousand were own-account positions.

 

The activities which had the biggest increase of the number of formal jobs was Public healthcare (169 thousand new jobs between 2000 and 2005), Other health-related products (163 thousand) and Trade of pharmaceutical, medical, orthopedic and odontological products (98 thousand). In this period, the number of jobs in hospital assistance services increased by only 16 thousand.

 

The activity with the biggest number of own-account positions and of workers without a formal contract was that of Other health-related activities, with trend to increase for these two types of participation. The number of jobs without a formal contract in public healthcare may be associated with the hiring of worker’s cooperatives. Jobs in cooperatives may be classified as own-account positions. The trade of pharmaceutical, medical, orthopedic and odontological products and private social services were also highlights among the occupations without a formal contract and with own-account workers.

 

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¹ The delimitation of the health sector occurred in accordance with the economic activities considered typically health-related as stated in the National Classification of Economic Activities 1.0 (Cnae 1.0).

 

² Value added (VA) is type of measurement for the income generate by each activity. It corresponds to the difference between the production value and the intermediate consumption of the activity. For a private hospital, for example, taking the expenditure with electricity, medicines, outsourced cleaning services and security and other expenses with acquisition of goods and services out of the production value of, we obtain value added, that is, the amount added by the hospital to the economy of the country. GDP is equals to value added of all economic activities plus the taxes charged on goods and services.  

 

³  In National Accounts, the activity public healthcare encompasses the item classified in the function “health” in the administrative registers and information systems of public administration. It includes, mainly, health actions related to the Unified Health System (SUS) and financially supported by public health organizations. The data relative to public health do not include the production of university, military and penitentiary hospitals.

 

⁴  Together with Hospital assistance and Private social services, other activities related to healthcare form private health services. Other health-related activities include appointments and medical and odontological treatments, medical care offered in the patient’s household, services of support to diagnosis, activities performed by professionals such as nurses, nutritionists, psychologists, occupational and speech therapists, physiotherapists, etc, besides veterinaries.

 

⁵  The change of the volume of VA and its increase in real terms, not considering price rises.

 

 

⁶  The final consumption of health belongs completely to families. Their members are always the final consumers of public healthcare, private healthcare, medicines, therapies, exams and so on, but consumption cannot be financed directly by the consumer. In the System of Nastional Accounts, the sectors with final consumption expenditure of goods and services are families (by paying directly or with the mediation of health insurance systems), the government (which offers publioc services and contarcts services in public establishments associated to SUS) and non-profit institutions at family service (which include expenditure with NGO’s, churches, etc).

 

⁷  National accounts consider a local unit a company, or part of a company, located in a single place, in which only one production activity is performed, or in which the man part of value added comes from the main activity. For each activity there was the calculation of the number of workers directly employed in the local units, with a formal contract, without a formal contract or as own-account workers. 

 

⁸  Mixed income is the revenue of companies of own-account workers, in which it is not possible to separate revenue from the capital generated by work.