From 2002 to 2005, the number of health care units in Brazil increased by 17.8%. In 2002, 146 cities did not have health care units and, in 2005, this type of service was not offered in only six of the 5,564 Brazilian municipalities. In this same period, outsourcing increased in all the Regions, especially in the Northeast. The North and the Northeast Regions concentrate most of the public sector. These data are part of the survey Health Statistics - Medical-Sanitary Assistance - 2005, which is conducted by IBGE and supported by the Ministry of Health and shows that there are 2.9 local health care units for each group of 1,000 inhabitants. Another highlight of the survey was the supply of mammography equipment and ultrasound exams, which increased in all the areas, especially in the North and Northeast Regions.

AMS investigated all the health establishments existing in the country, either private or public, profit or non-profit, with a system of clinical service or hospital stays, including the establishments working with support to diagnosis, therapy and regular control of zoonoses.  Local Health Care Units, Health Centers, Clinics or Health Assistance Units, Emergency Units, Mixed Units, Hospitals (including those of military corporations), Units for Complementation of Diagnosis or Therapy, Radiology Clinics, Rehabilitation Clinics and Laboratories of Clinical Analysis.

Between 2002 and 2005, there was increase (17.8%) of the number of active health establishments, which changed from 65,343 to 77,004. The survey detected the existence of 83,379 units, being 3,606 inactive and 2,769 extinct. In relation to the number of establishments, the public sector had the biggest annual increase rates in the Northeast (7% a year) and Southeast (5.8% a year), whereas the private sector grew most in the Central West (15.2%) and in the South (5% a year).

Almost 70% of the private health care units with staying services receive SUS patients

The health establishments which do not offer staying services, but only clinical appointments, totaled 55,328, that is, 19.2% more than in 2002. Although the increase rate has been higher in the private sector (7.4%) than in the public one (5.6%), most of the health care units without staying services (74.6%) are public. The medical assistance offered by units without staying services is focused on medical categories (75%), whereas the service for other categories is present in 24.4% of the establishments. In the case of Psychiatry, it is present in 4.5% of them. Basic immunization is offered in 29,653 establishments without staying services.  

The tendency to reduction of the number of establishments with staying services was confirmed by the 2005 edition of AMS. They made up 9.3% of the units surveyed in 2005, having reached the figure of 7,155, reduction of that is 243 establishments in relation to those registered in the previous survey. In 2002, they were 11% of the total of units, whereas in 1999, 16%. In the period 2002/2005, there was increase from 35% to 38.1% of the participation of public establishments with staying services, whereas the percentage of private establishments with staying services fell in all the regions. Also with reference to hospital stays, the overall percentage of hospitals units taking care of SUS patients reached 78.9%, that is, 5,644 units. This figure was higher in the Northeast (87.6%) and in the Southeast (83.9%) Regions.

Focusing on the private sector, approximately 68% of the establishments with staying services receive SUS patients. In the South region, this figure reaches 81.3%; in the Northeast, 73.8%, and in the Southeast, 60.8%. In terms of specialization, 12.9% of the units in the private sector are specialized, whereas in the public sector 5.0% of them are. The availability of emergency services reached 67.5% in the health units which offered staying services.

Private sector holds most of the services which support diagnosis and therapy

Approximately half of the group of health unit surveyed (41,943) declared to have some kind of service which supports diagnosis and therapy. Most of them (26,480) belong to the private sector, whereas 15,463 form the public sector. From this total, 14,521 are establishments which perform this kind of service, specifically. Radiotherapy and magnetic resonance are among the least available services in the country, whereas clinical analysis and medical ultrasonography are among the most commonly offered ones. The supply of services such as cintilography and videolaparoscopy is higher in the establishments which attend SUS patients.

Chemotherapy is offered in 686 units, and 456 of them have staying services. High complexity treatment of AIDS is offered by 7.6% of these health units. Heart surgeries are offered by 2.4% of the public establishments with staying services, and in 8.7% of them of private health units, among which 50.3% attend patients benefited by SUS.

Public Sector does not increase number of beds for hospital staying

According to the survey, there were 443,210 beds, being 148,966 (33.6%) public and 294,244 private (66.4%) private. Between 2002 and 2005 there was decrease of 27,961 beds, equivalent to a reduction of 5.9% in the total, or a decrease rate of 2.0%.

The decrease of the number of beds is concentrated in the private sector, and it occurred in all the areas, with loss of 3.2% in this period. Of the total of private beds, 82.1% belong to establishments which declared to attend SUS patients. On the other hand, in the public sector, there was increase of 1.8% in the same period, with 17,189 federal, 61,699 state and 70,078 municipal beds. However, only in the North and Central West Regions did the offer of beds in public hospitals was in proportional to the population growth. The North Region is the one which holds the biggest percentage of public beds (57.7%), followed by the Northeast (45.3%) and Central West (36.6%). In the Southeast Region, the proportion is 27.9% and the South Region has the lowest percentage, 19.9%.

In 2005, the ratio bed for 1,000 inhabitants was 2.4. In 2002, this index was 2.7. The parameter indicated by the Ministry of Health is 2.5 - 3 beds by inhabitant. The private sector accounted for most of the decrease of this index (4.9% a year). In the public sector, the decline was 1.2%. Decrease of the indicator was observed in all the Federative Units, being Roraima (31.8%) and Amapá (24.7%) the ones with the biggest reduction. It is important to highlight that these states are among those presenting the lowest proportion of the indicator, with 1.5 and 1.2 beds by 1,000 inhabitants, respectively. Besides these, other places offer less than 2 beds for 1,000 inhabitants: the states of Amazonas (1.6), Sergipe (1.8) and Pará (1.9). The result of AMS 2005 shows only eight states with indicators of bed for 1,000 inhabitants over or under 2.5. They are: Paraíba (2.5); Pernambuco (2.5); Santa Catarina (2.7); Mato Grosso do Sul (2.7); Paraná (2.8); Rio Grande do Sul (2.8); Goiás (2.9) and Rio de Janeiro (2.9).

North Region is the leader in term of public hospital staying

The number of stayings registered by AMS 2005, relative to 2004, was 23,252,613, being 7,022,089 in public establishments and 16,230,250 in private ones, representing an increase of 16.3% in relation to 2002. From the total number of stayings, 46.4% occurred in the Southeast Region, 22.6% in the Northeast; 15.8% in the South; 7.7% in the Central West and 7.5% in the North. The Southeast Region, with 28.3% and the North, with 19.7%, were the ones which presented the highest increase of the number of staying in the period 2001/2004. In the South Region, the increase was 7.1%; in the Northeast, 5.8%; in the Central West Region, 3.9%.

The participation of the public sector in the overall staying services is bigger in the North (63%), Northeast (43%) and Central West (40%) and less significant in the Southeast (21.4%) and in the South Region (17.2%). In this sector, the number of stayings increased in relation to 2001, except in the South Region which had decrease of 1.4%. In the private sector, the number staying services decreased only in the North Region (15.7%) and in the Central West Region (10.3%). In the Southeast region, the increase was 32.8%. The private establishments which declared to attend SUS patients accounted for 65.5% of the stayings in this sector. The average number of stayings by bed changed from 42, in 2002, to 52, in 2005. The annual increase of this index between 2002 and 2005 was bigger among private beds (8.8%), than among public ones (4.3%). The public establishments had bigger increase of this indicator in the North Region (11.2%), and the private sector, in the Southeast Region (13.2%).

As for the staying rate, the number of hospital stayings for 1,000 inhabitants in Brazil was 12.8. In 2001, this rate was 11.6. In the Central West, Southeast and South Regions, this indicator was higher than the national average, and the rate for these regions was about 14 for 100 inhabitants. In the North Region, this indicator was 12.2 and in the Northeast, 10.4 hospital stayings for 100 inhabitants. Between 2001 and 2004, only the Central West Region had relative decrease of the staying rate (3.3%).

Number of doctors in public health establishments increases

Approximately 51.0% of the working positions for those who have higher education are health establishments with staying services. In the case of positions for doctors and nurses, this percentage is even higher, reaching 56.6% and 57.2%, respectively. In terms of positions for technicians and auxiliaries, the situation is not different, and the establishments with staying services receive 65.8% of these professionals. For nurses - auxiliaries and technicians, these percentages reach 70.7% and 73.3%, respectively.

The average number of doctors for health establishment is 6.9, but in the establishments with staying services this value reaches 41.7. For the working positions of technical/auxiliary level, the average is 9.8 positions per establishment, and the places offering staying services have, on average, 69 working positions for technicians/auxiliaries.

The public sector accounts for 50.7% of the working positions for higher education and for 54.1% of those for technicians/auxiliaries. However, in the case of positions for doctors, the numbers are different: in the private sector there are, on average, 9 positions by establishment; in the public sector, this average falls to 5.4. For technicians/auxiliaries, there are, on average, 9 positions for the public sector and 10.8 for the private one.

Whereas the public sector holds 60.5% of the positions for auxiliary nurse, in the private sector we find 57.6% of the positions for nurse technicians.

The number of positions in health establishments in 2005 was 527,625, representing a relative increase of 13.2% in relation to 2002. The number of positions foe doctors in health establishments for 1,000 inhabitants changed from 2.7, in 2002, to 2.9, in 2005. This indicator increased in relation to 2002, changing  from 4.1% in the South Region, to 14.6% in the Central –West Region. In the establishments with staying services, this increase was 13% in the public sector and 8.7% in the private sector.

Supply of medical equipment increases in the North and Northeast Regions

The supply of equipment with more advanced technology, such as mammography and tomography and ultrasound equipment increased in all the regions of the country. In the North and Northeast, mainly, where the supply of equipment is lower, the number of mammography appliances for 100 thousand inhabitants had annual growth of 12.8% to 9.5%, respectively, in relation to 2002. These values are above the national average of growth, which was 7.3%. Still in the Northeast, the supply of tomographs for100 thousand inhabitants changed from 0.5, in 2002, to 0.6, in 2005. For the country, the country, this indicator was 1.1 in 2005.

The supply of ultra sound appliances for 100 inhabitants in the Northeast region increased by 19.5%. In the country, the average was 7.7 appliances for 100 thousand inhabitants. In the Northeast, this indicator was 6.7 for 100 inhabitants.

As for hemodialysis equipment, only 9.8% belonged to the publis sector. Private sector establishments financed by SUS held 82.5% of the appliances. The establishments with staying services have 52.1% of all the equipment, and the supply in the private sector was 2.6 times that of the public one. For hemodialysis equipment, the rate was 7.9 appliances for 100 inhabitants. In the North region, however, where this indicator is 3.1 for 100 inhabitants, there was annual increase of 9.0% in the period between 2002 and 2005. The biggest increase, however, occurred in the Central West region, in which the indicator was 8.3 for 100 thousand inhabitants.

The supply of X-ray equipment fell by 1.8% in the year, in comparison with 2002, in all the Regions. The biggest decrease occurred in the Southeast Region, 2.8%. The public sector held only 29.4% of the X-ray equipment, and the supply of these appliances in establishments without staying services was low, since only 4.5% of them had this kind of equipment. The number of X-ray appliances per establishment with staying service was 1.4 in the public establishments and 1.7 in the private ones.