Search

O objetivo desse trabalho é estudar o efeito do aumento da taxa de sobrevida sobre os gastos com saúde no Brasil. Usando os dados sobre expectativa de vida, taxa de sobrevida e gastos com saúde no Brasil, estimamos uma regressão com variável instrumental para estudar a correlação endógena entre longevidade e gastos com saúde. Por um lado, o aumento da longevidade da população gera uma maior demanda sobre os gastos com saúde (público e privado). Por outro lado, o aumento dos gastos com saúde tende a aumentar o tempo de vida das pessoas. Com isso, usamos o fato de que ao estabelecer os gastos públicos com saúde do ano seguinte, o policymaker observa a taxa de sobrevida e a expectativa de vida do ano anterior. Esse atraso informacional do policymaker afetaria os gastos com saúde tanto na provisão de gasto público direto quanto no indireto. Os resultados desse trabalho demonstram que ao errar a taxa de sobrevida da população brasileira, o governo subestima os gastos diretos e indiretos com saúde. Isso gera uma redução de fato nos gastos de saúde por pessoa atendida no sistema público. Além disso gera um efeito substituição entre os gastos com saúde: aumenta os gastos com isenção de imposto de renda (gastos tributários indiretos), reduz os gastos com saúde pública universal (gastos diretos). The objective of this work is to study the effect of the increased survival rate on health spending in Brazil. Using data on life expectancy, survival rate and health expenditures in Brazil, we estimate a regression with an instrumental variable to study the endogenous correlation between longevity and health expenditures. On the one hand, the increase in the population's longevity generates a greater demand on health spending (public and private). On the other hand, the increase in health spending tends to increase people's life span. With this, we use the fact that when establishing public spending on health for the following year, the policymaker observes the previous year's survival rate and life expectancy. This policymaker's informational delay would affect health expenditures in both direct and indirect public expenditure provision. The results of this work demonstrate that when the Brazilian population's survival rate is wrong, the government underestimates direct and indirect health expenditures. This generates a de facto reduction in health expenses per person served in the public system. In addition, it generates a substitution effect between health expenditures: it increases expenditures exempt from income tax (indirect tax expenditures), it reduces expenditures on universal public health (direct expenditures).

BACKGROUND: Women living with HIV (WLWH) and sex workers (SWs) are priority populations for HIV prevention, diagnosis, treatment, and care. There is limited research into the impacts of structural (e.g., laws) and interpersonal violence (i.e., physical, sexual, verbal) on access to necessities (e.g., food, housing), HIV treatment, or the relationship between violence and HIV stigma. This thesis investigated the role of structural and interpersonal violence in an environment of HIV non-disclosure criminalization, in food insecurity among SWs living with and affected by HIV, and in antiretroviral (ART) adherence. METHODS: Data were drawn from two community-based prospective cohort studies, An Evaluation of Sex Workers’ Health Access (AESHA) and Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA). Bivariate and multivariable logistic regression were used to examine the correlates of physical and/or verbal violence due to HIV disclosure without consent among WLWH in the SHAWNA cohort. Bivariate and multivariable logistic regression using generalized estimating equations (GEE) were used to model correlates of food insecurity among SWs in the AESHA cohort. Finally, a multivariable confounder model was created to assess the independent relationship between ART adherence and physical and/or sexual violence for WLWH in the SHAWNA cohort. RESULTS: Among 255 WLWH enrolled in SHAWNA between 2010-2016, bivariate and multivariable logistic regression showed that WLWH who were “outed” had elevated odds of experiencing physical and/or verbal violence (Objective 1). In AESHA, among 761 SWs living with or affected by HIV between 2010-2014, bivariate and multivariable logistic regression using GEE revealed increased odds of food insecurity for SWs who experienced physical and/or sexual violence (Objective 2). Among 250 WLWH enrolled in SHAWNA between 2014-2017, bivariate and multivariable logistic regression using GEE found decreased odds of optimal ART adherence among WLWH who experienced physical and/or sexual violence (Objective 3). CONCLUSIONS: Structural and interpersonal violence are important factors in the health needs and outcomes of SWs and WLWH. Universally applied trauma-informed care by primary healthcare providers is crucial. The decriminalization of sex work and HIV non-disclosure must be a priority. Given the high proportion of Indigenous women represented in this thesis, culturally relevant programming must be accessible.