The number of completely or partially active health establishments increased from 77 thousand in 2005 to 94 thousand in 2009 (22.2%). Out of the 52 thousand active public health units, a total 95.6% are municipal; out of the 42 thousand private ones, 90.6% are for-profit institutions. The number of establishments without hospitalization services increased with the total number of units, by 22.7%, 2005 and reached 67.9 thousand in 2009, what corresponds to 72.2% of the total surveyed.  The proportion of public establishments without hospitalization services has been decreasing gradually, and the sector has increased only 3.5% a year from 2005 to 2009, versus 9.9% a year in the private sector, in which the main highlights were the North (16.4% a year) and South (12.1%).  The 19.3 thousand existing establishments of exclusive support to diagnosis and therapy (SADTs) make up 20.5% of the health units active in 2009. Among them, 90.8% are private.  

 

Considering the total number of establishments without hospitalization services, only 39.3% offered services of support to diagnosis or therapeutic procedures, versus 90.4% of establishments with hospitalization services.  Among these, in the public sector, the percentage was 92.3% and, in the private sector, 89.2%.  Between 2005 and 2009, Brazil had minus 390 establishments with hospitalization services in the private sector.  The public sector increased its supply of hospitalization services by 112 establishments, what resulted in net loss of 280 units.  The North Region was the only one to record increase (2.3%) in the supply of hospitalization services, whereas all the others faced decrease, being the main highlight the Central West (-7.8%).  The number of beds for hospitalization has also been reduced:  there were minus 11,214 beds between 2005 and 2009. Out of the 431.9 thousand beds registered, 152.8 thousand (35.4%) were public and 279,1 thousand (64,6%) were private ones.  The national rate in 2009 was 2.3 beds/one thousand inhabitants, below the parameter established by the Ministry of Health, of 2.5 to 3 beds/one thousand inhabitants; the South Region alone remained at this level, with 2.6 beds/thousand inhabitants. Between 2005 and 2008, the number of hospitalizations decreased by 0.2%, with almost 23.2 million hospitalizations, out of which 15.0 million took place in the private sector.

 

The supply of almost all hospital equipment increased, in spite of remaining regional differences.  The offer of magnetic resonance imaging increased by over 100%, from de 415 to 848 establishments between 2005 and 2009. In the North Region, where the general supply of equipment is lower, the number of mammograms/100 thousand inhabitants changed from 0.8 in 2005 to 1.1 in 2009. Considering sonographic machines, the biggest annual increase (7.7%) occurred in the South, where the supply/100 thousand inhabitants (11.0) was above the national average of 10.1. The supply of hemodialysis machines was 9.8/100 thousand inhabitants; the Northeast had the biggest increase (9.2% a year) and the indicator there was 7.6/100 thousand inhabitants. Among these machines, only 10.3% belonged to the public sector. The private sector, financed by, the Unified Health System (SUS) accounted for 83% of the machines.  These and other relevant data are available on the Survey of Medical and Sanitary Assistance (AMS) 2009, done in partnership with the Ministry of Health, which investigated all the health establishments, either public or private ones, with or without hospitalization services, all over the country, with geographic location via GPS and electronic questionnaires filled out on the Internet.

 

AMS 2009 recorded in 2009 a total 105,270 health establishments, being 3,741 non-active (which were not in action, but might be reopened), 4, 080 extinct ones (that is, whose activities had been permanently stopped), 96,450 active and 999 partially-active ones (in action, but with at least one activity suspended or permanently stopped).  The analysis of indicators was based on the 94,070 partially active or active health establishments with no kind of outsourced work.  

 

95.6% of the public health establishments in the country are municipal

 

The number of completely or partially-active health establishments increased from 77 thousand in 2005 to 94 thousand in 2009 (22.2%), that is, by 22.2%, what corresponds to an annual growth rate of approximately 5.1%.  Out of the 52 thousand public health units active, a total 95.6% are municipal, 1.8% federal and 2.5% state institutions. Out of the 42 thousand private establishments, 90.6% were for-profit, versus 87.9% in 2005, with a trend to decrease of the proportion of non-profit establishments. Establishments associated to the Unified Health System (SUS) which, in 2005, accounted for 30.6% of the private establishments, fell to 27.1% in 2009.

 

In 2009,  SUS remained as the most common financing source for health establishments, having reached 67.2%, in spite of its slight decrease in participation compared to 2005, when it was 70.9%. In second place came the direct (private) payment of activities, present in 42.7% of the establishments, followed by health insurance plans, with 35.5% and private plans, in only 2.8% of the establishments.

 

Number of establishments without hospitalization services increased 22.7% from 2005 to 2009. 

 

In 2009, the 67.9 thousand health establishments without hospitalization services (such as, for example, the ones which had only ambulatory and emergency services) accounted for about 72.2% of the total surveyed, with increase of 22.7% in relation to 2005. The biggest percentage of establishments without hospitalization services (69.8%) in the scope of the survey (which does not include private medical offices, for instance) is in the public sector. Nevertheless, this figure has been reduced, as the sector recorded increase of 3.5% a year, versus 9.9% of the private sector, in the period surveyed. The North Region recorded the biggest level of increase in the private sector without hospitalization (16.4% a year), followed by the South Region (12.1%), whereas the smallest level of increase was that of the Central West (6.0%).  In the public sector, the increase indexes were smaller, ranging from 1.2% in the North and 4.7% in the Northeast.

 

Establishments without hospitalization services have different profiles, according to their nature: whereas 72.4% of the public establishments offered general care and only 6.0% offered specialized care, in private establishments only 3.2% offered general care and 60.4%, specialized care. 

 

Medical health care offered by the establishment without hospitalization services with ambulatory care was essentially concentrated on basic specialized services (75.3%) and care of other type was offered in only 26.5% of these establishments. Considering psychiatry, this percentage was even smaller, and did not surpass 5.4%. Ambulatory care without doctors (including immunization, midwifes, etc) was offered in 8,017 establishments without hospitalization services all over the country, with biggest figures coming from the North (20.6%) and Central West (20.0%). In the South, only 10.7% of the establishments without hospitalization provided this service.  Among the 6,118 establishments with neonatal units, 33.7% did not offer hospitalization services.

 

90.8% of the establishments offering exclusively examinations and therapeutic procedures are private

 

The 19.3 thousand establishments offering exclusively support to diagnosis (examinations) or therapeutic procedures (SADTs) made up, in 2009, 20.5% of the total active health establishments, versus 17.6% in 2002. Among these, 90.8% belonged to the private sector, but the public sector increased its participation in this group from 7.5% in 2005 to 9.2% in 2009. Increase in the period was 12.5% a year for the public sector and 6.9% for the private sector. The biggest indexes of annual increase for this type of service in the public sector occurred in the Northeast 18.5%) and Southeast (11.9%).  

 

Exclusive SADT establishments made up 55.8% of the total number which declared to perform clinical analysis; 55.1% offered pathologic anatomy, 26.65%, medical ultrasonography and 36.3%, tomography.

 

Services of support to diagnosis (examinations) or therapeutic procedures have also been reported by 32.9 thousand establishments with or without hospitalization and that offered this type of service in their facilities (except 22.3 thousand establishments that only conducted immunization services).

 

Considering the total number of establishments without hospitalization services, only 39.3% offered services of support to diagnosis or therapeutic procedures, versus 90.4% of establishments with hospitalization services.  Establishments without hospitalization had 5.2% availability of clinical analysis services, 2.0% for pathologic anatomy, 3.0% for medical radiology and 6.8% for dental radiography. Electrocardiograms, featuring as one of the most commonly offered services, was only present in 8.5% of these establishments, characterizing a low supply of diagnosis-support examinations in them.

 

In a general way, the most commonly reported services, in decreasing order, were: clinical analysis, physiotherapy, electrocardiography and medical radiology.  Among the least offered services in the country, the main ones were radioimmunoassay, radiotherapy, scintigraphy, lithotripsy and hemodynamic. 

 

Occurrence of hospitalization services and number of beds increase in the North Region and decrease in the rest of the country

 

The deactivation of private establishments with hospitalization services confirms the trend to immediate decline observed since 1999. The private sector has lost 390 establishments with hospitalization services in the period between 2005 and 2009. The public sector recorded increase of 114 establishments, resulting in 276 establishments with hospitalization and pointing to increase in the relative participation of the public sector in the supply of this type pf service, which increased from 35%, in 202, to 41.3%, in 2009.  

 

The North Region was the only one to record increase (2.3%) in the supply of hospitalization services. the highlights among the other Regions were the Central West (-7.8%) and the Northeast (-5.6%). In the public sector, the increase of supply was most significant in the North (9.3%) and Southeast (7.3%).  

 

Similarly to the trend observed in establishments with hospitalization services, beds also faced decrease of offer by 11214 beds in the comparison between 2005 and 2009. A total 432 thousand beds have been registered, being 152.9 thousand (35.4%) public and 279.1 thousand (64.6%) private ones.  Once more, the North Region was the only one to have increase of 4.2% in the total number of beds in relation to 2005. Private beds in the country faced decrease of 5.1% in the period considered. The parameters of the Ministry of Health range from 2.5 to 3 beds/one thousand inhabitants. The national rate in 2009 was 2.3 beds/tone thousand inhabitants. The South Region was the only one to reach the official parameter, with 2.6 beds, whereas the North and Northeast Regions remained as the most deprived ones (with 1.8 and 2.0 beds/one thousand inhabitants, respectively).

 

SUS finances 79.4% of the emergency services

 

In 2009, emergency services in the country amounted to 6,999 establishments distributed as follows: in the Southeast, 2,712; in the Northeast, 1,791; in the South, 1,228; in the Central West, 673; and in the North, 591. The Unified Health System (SUS) was the financing source of 79.4% of them, followed by the direct payment by private users (in 42.8% of the establishments) and by health insurance plans (42.4%).

 

In 2008, hospitalizations in private health institutions surpassed those in the public sector by two times

 

The number of hospitalizations in 2008 recorded by AMS 2009 was approximately 23.2 millions, with a record of relative decrease (-0.2%) in relation to hospitalizations in 2004. In the two years analyzed, although the difference has been reduced and the general increase has been maintained by the public sector, the private sector was predominant (16.5 million in 22004 and 15.0 million in 2008).  

 

The behavior of hospitalizations in the period 2004/2008 was not uniform in all the Regions of the country, having been negative in the Southeast (8.5%) and North (-4.4%), whereas the main positive highlight came from the Central West (12.7%).

 

The participation of the public sector was biggest in the North (62.8%) and Northeast (50.5%), being below 35.0% in the other regions. In this sector, the number of hospitalizations decreased in relation to 2004 in the North (-0.6%), Central West (-2.9%) and South (-4.8%). In the Southeast, there was increase of 27.1%; in the Northeast, of 25.2%.

 

On the other hand, in the private sector, the number of hospitalizations did not present decrease in the South (12.4%) and Central West (23.1%) only. In the Southeast, decrease reached -18.3%. Private establishments that declared to render services to SUS accounted for 72.4% of the hospitalizations in this sector.  In the South, this contribution reached 83.6% of the total hospitalizations in the private sector. In the Northeast, this figure was 75.8%; in the Central West, 67.0%; in the Southeast, 67.4% and in the North, 61.1%. 

 

The average number of hospitalizations per bed changed from 52 in 2005 to 54 in 2009. The annual increase of this index in the period for public beds was 3.1%. In private beds, there was decrease of 0.6%. 

 

The number of hospitalizations/one hundred inhabitants decreased from 12.8% in 2005 to 12.2 in 2009. In the North, the indicator was 11.5 and, in the Northeast, 10.5. Between 2004 and 2008, the Southeast presented relative decrease of -11.7 and the North, of -9.2% in the hospitalization rate.

 

Capitals held 40.2% of medical job posts

 

According to AMS, the offer of higher education job posts increased 26.9% between 2005 and 2009 (from 870.4 thousand to 1.1 million).This increase was most significant in the North (42.0% in the period). In the other regions, increase ranged between 21.8% and 28.3%. 

 

In 2009, physicians made up the majority of professionals among those with higher education level: 57.6% (636 thousand), followed by nurses, with 14.8% (163 thousand).

 

Considering the total number of higher education job posts, 51.4% were found in the Southeast, followed by the Northeast (21.4%), South (15.2%), Central West (7.0%) and North (5.0%).   The distribution of medical posts follows the same order: Southeast (54.2%), Northeast (19.4%), South (15.0%), Central West (6.7%) and North (4.6%). 

 

When analyzing the distribution of medical job posts/one thousand inhabitants in 2009, the Southeast remains as the leader (with 4.3 job posts per one thousand inhabitants), followed by the South (3.4), Central West (3.1), Northeast (2.3) and North 1.9). The national average was 3.3.

 

The number of vacancies did not go together with the population distribution. capitals, which held 23.7% of the population in 2009, held 40.2% of the medical posts (5.6/one thousand inhabitants in capitals and 2.6 in other municipalities).  In 2005, the ratio was 5.1/one thousand inhabitants in capitals and 2.2 in other municipalities.  The concentration in capitals in 2009 was most significant in the South Region (7.8/one thousand verus 2.8/one thousand in the other municipalities. 

 

Doctors working in health establishments concentrated their activities into ten different fields: as general practitioners (16.7%), pediatricians (10.0%), gynecologists and obstetricians (9.5%), Family Health Program physicians (6.3%), general surgeons (5.2%), orthopedists (5.5%), cardiologists (5,2%), anesthesiologists (4,3%), radiologists (3,7%) e ophthalmologists (3,3%).

 

The private sector held 55.7% of the medical job posts, versus 44.3% of public ones.  Since 1999, the private sector has offered most of these job posts, being the main highlight the Southeast (58.5%), South (64.3%) and Central West (54.7%). Jobs as civil servants were the majority in the North (62.2%) and Northeast (54.1%). 

 

Among medical job posts of technician/auxiliary level by occupation, there was predominance of the subarea for nurses, with 72.9% (35.7% auxiliary and 37.2% technician nurses) – a little below the result of 2005 (74.9%, with 53.4% of auxiliary and 21.5% of technician nurses). There was improvement in the qualification of nurse teams, increase of 101.1% in medical job posts for technicians and decrease of 21.0% of posts for auxiliaries.

 

From 2005 to 2009, unevenness in the offer of medical equipment decreased in the North Region

 

AMS 2009 indicates that, although there is major regional unevenness in the supply of hospital equipment, practically all of them have recorded increase since 2005. Those which have advanced technology, such as mammographs, tomographs and ultrasonography were more often available in all the areas in the comparison between these two periods – one with highlight for magnetic resonance, which, in 2005, was one of the least offered services (415 establishments) and became 848 in 2009, with increase of more than 100% in the period. 

 

In the North, where the offer of equipment is smaller, the number of mammographs/one thousand inhabitants changed from 0.8 to 1.1 (annual increase of 7.0%, above the national average of 5.3%).  Also in the North, the offer of tomographs/100 per one thousand inhabitants changed from 0.48 to 0.87 between 2005 and 2009, being slightly above half of the national average (1.6).  

 

For ultrasonography equipment, the biggest annual increase (7.7%) occurred in the South, where the offer of these machines/100 thousand inhabitants was 11.0, above the national average of 10.1. On the other hand, in the North, the indicator was 6.9/100 thousand.

 

In terms of hemodyalisis equipment, the figure was 9.8/one 100 thousand inhabitants.  The Northeast recorded the biggest increase (9.2% a year) and the indicator there was 7.6/100 thousand.  In the Southeast, this indicator was 12.0/100 thousand and the annual increase rate between 2005 and 2009 was 6.0%.  In this group of equipment, only 10.3% belonged to the public sector, and the private sector financed by SUS held 83% of the machines.  Establishments with hospitalization services gathered 32.8% of this equipment, and the offer of these establishments in the private sector was three times bigger than in the public one.

 

There was increase of the annual offer of x-ray machines/100 thousand inhabitants in the North Region, by 1.9% a year, with change from 5.8 (2005) to 6.3 (2009).