Diagnostic imaging in Brazil: a system, many realities

Abstract

Objectives: The way health systems are financed is a critical determinant for reaching universal coverage. Little has been published characterizing specific patterns of the dramatic rise in diagnostic imaging during the past decade. The study aimed to verify which socioeconomic, structural and demographic variables are associated with the expenditure of highly complex outpatient diagnostic imaging in Brazil. This type of analysis would allow those interested in cost containment to understand where most imaging and most expense occurs. Methods: Data were collected from 2008 to 2016 from Datasus system with the software TabWin version 1.4.1. Results: The present study showed that the dramatic rise in imaging raises both costs and radiation exposure. Several factors have contributed to this increase, including wider availability of technology, increased demand by patients and physicians, favorable reimbursement, and improvements in the technology resulting in a lower threshold for using it. The study also showed that there is a concentration of per capita outpatient expenses with diagnostic imaging in the macroregions with the best infrastructure. Conclusions: A more concerted effort to reduce administrative costs is needed. Inefficiencies are likely the product of a number of factors including the administrative complexity of the Brazil health care system and the lack of price transparency across the system.