Análises espaciais em saúde para os municípios brasileiros: ciclos eleitorais e partidários, estratégia saúde da família e migração médica

Abstract

This thesis aims to analyze spatial health issues in Brazilian municipalities. Thus, article investigates the evidence of electoral and partisan cycles and spatial interaction in health and sanitation expenditures. The spatial dynamic panel model allowed us to observe whether there is an increase in health and sanitation expenses in the years of municipal elections and which parties spend the most on health and sanitation. Identified that the pattern of these expenditures is influenced by the behavior of expenditures in neighboring municipalities. The spillovers effect is noticeable, as governors reduce their health and sanitation expenditures by observing that neighbors increase expenditures. Article 2 analyzes the spatial issues of the Family Health Strategy (FHS) that can influence the infant and child mortality rate of 1 to 4 years in Brazilian municipalities between 1998 and 2012. The estimation is given by data per space panel. As a result, the effects of the feedback type are observed, in which the direct effects of the FHS pass to the neighbors and return and the spreading of the coverage ratio of the neighbors in the reduction of the infant mortality and from 1 to 4 years. Thus, it is concluded that an increase in FHS in one municipality reduces infant and 1 to 4 year mortality rates in neighbors, and this effect is higher for infant mortality. And article 3 analyzes the medical migration, identifying if there is trickle down effect in Brazilian municipalities for general practitioners and specialists. Data from the Censo 2010 and the two-level spatial hierarchical model are used, the first with the individual data and the second with the municipal data (incorporating spatial lags). As a result, the importance of including individual, municipal and spatial variables is confirmed and there is no trickle down effect for medical migration, either by generalists (who are dispersed by the municipalities at random) or by specialists in the Brazilian municipalities.