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Pediatric hemodialysis is an essential treatment for children with advanced chronic kidney disease (CKD), but its cost is high and can burden the family budget. The Brazilian public health system (SUS) is responsible for ensuring universal access to healthcare in Brazil, including hemodialysis. In this sense, it is important to understand SUS spending on this type of treatment to evaluate the allocation of public resources for health care and promote improvements in the quality of life of children who require pediatric hemodialysis. The aim of this study is to analyze SUS spending on pediatric hemodialysis in Brazil in the pre- and post-pandemic periods.
This is a descriptive quantitative study on SUS spending on pediatric hemodialysis, as well as the impact of the COVID-19 pandemic on its investment, based on data obtained by DATASUS (public health system data set from Brazil) between January 2017 and January 2023. Approximate values were used, in American dollars (U$), in the quotation at the time, using an average of values adopted, in the pre-pandemic period, from January 2017 to December 2019 and, in the post-pandemic period, from January 2020 to January 2023, due to the floating exchange rate.
Pre-pandemic period: in the North region, there was a peak in spending (PIS) in 04/2017, standard deviation (SD) was U$140.290,94 with an average of U$24.356,16 and, overall, a decreasing trend line (DTL); in the Northeast, there was PIS in 05/2018, SD of U$6.511,46 with an average of U$18.238,61 and showing DTL; in the Southeast, there was PIS in 08/2018, SD was U$10.143,85, with an average of U$99.191,83 and DTL; in the South, there was PIS in 10/2019, SD of U$3.023,50, with an average of U$19.887,74, together with an increasing trend line (ITL); in the mid-west, there was PIS in 04/2019, with SD of U$4.416,84, average of U$15.177,49 and ITL. In the post-pandemic period: in the North, there was PIS in 07/2021, SD of U$4.227,26, Average of U$41.529,20 with DTL; in the Northeast, there was PIS in 12/2022, with SD of U$12.861,49 and an average of U$93.029,92 with ITL; in the Southeast, there was PIS in 06/2022, with SD of U$15.220,05 average of U$127.011,06 and ITL; in the South, there was PIS in 09/2020, with SD of U$3.044,07, average of U$32.866,95 and DTL; in the central-west, there was PIS in 12/2022, with SD of U$6.859,22 and an average of U$13.274,40 with ITL.
These data indicate an increase in SUS spending on pediatric hemodialysis, with variations between the five regions of Brazil. The North had the highest increase (39.84%), while the Southeast had the lowest (5.02%). Despite the 28.26% reduction in the Central-West region, total spending increased by 12.26% nationally. Therefore, it is possible to attribute such differences to different government strategies, as well as different health demands. Investigations of this type require greater emphasis, with a view to better understanding the impacts of the pandemic on the country's health system.