Access to hospitalization in Brazilian municipalities in 2000: territorial distribution in the Unified National Health System

Abstract

This article investigates the effect of external factors on hospitalization patterns in Brazilian municipalities (or counties): supply, spatial configuration, socioeconomic aspects, and political context. Inpatient data from 2000 for individuals 15 years and over and most frequent hospital procedures, obtained from the National Hospital Information System (SIH-SUS), were aggregated by place of residence at the municipal level. Nested generalized additive mixed models were fitted using Bayesian inference. Probability of hospitalization is shown to increase with hospital bed supply and with primary care and local capacity, and to decrease with increasing distances and in larger and wealthier municipalities. Inclusion of random, State, and spatial patterns effects reveals regional differences in the probability of hospitalization and the main factors explaining such different patterns.