Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Empirical Strategy
2.2. Databases and Study Variables
2.3. Data Analysis
2.3.1. Pre-Tests of the Model
2.3.2. Estimation of the PSM-DID Model
2.3.3. Validation Post-Tests of the Results Found
3. Results
3.1. Health, Demographic, and Socioeconomic Characteristics of the Municipalities
3.2. Model Estimation Pre-Tests
3.3. Estimation of PSM, DID, and PSM-DID Models
3.4. Post-Estimation and Model Robustness Tests
4. Discussion
5. Conclusions
5.1. Limitations and Future Studies
5.2. Implications to Public Health
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Control (0) | Treated (1) | Relative Difference in Mean * (0/1) | p-Value | ||
---|---|---|---|---|---|---|
Mean * | SD | Mean * | SD | |||
Health | ||||||
Hosp spend per stroke ** | 4621.18 | 1155.20 | 11,886.13 | 1169.94 | −7264.94 | <0.001 |
No. of doctors ** | 14.22 | 0.92 | 68.94 | 9.3 | −54.71 | <0.001 |
No. of beds | 38.32 | 2.01 | 115.51 | 13.07 | −77.19 | <0.001 |
Demographic | ||||||
Pop > 40 years *** | 3847.14 | 119.76 | 8690.88 | 587.06 | −4843.74 | <0.001 |
Rt pass HS | 86.27 | 0.33 | 86.72 | 0.2 | −0.45 | 0.244 |
Socioeconomic | ||||||
GDP per capita | 275,452.22 | 16,022.33 | 289,650.13 | 10,824.95 | −14,197.90 | 0.480 |
Total Health Expenditure | 4,848,757.54 | 151,985.75 | 11,150,605.58 | 904,148.96 | −6,301,848.04 | <0.001 |
Variables | Before Matching | % Bias Reduction | After Matching | ||||
---|---|---|---|---|---|---|---|
Treated | Control | p-Value | Treated | Control | p-Value | ||
>40 years/10,000 inhab | 3154 | 3005.4 | <0.001 | 97.9 | 3138.7 | 3141.8 | 0.811 |
Log no. of doctors | 2.52 | 2.064 | <0.001 | 94.8 | 2.305 | 2.329 | 0.551 |
No. of hosp beds. SUS | 116.56 | 39.452 | 0.001 | 95.8 | 53.416 | 50.187 | 0.218 |
Presence of NASF | 0.586 | 0.561 | 0.292 | −1.4 | 0.568 | 0.593 | 0.161 |
Total Health Expenditure | 105,912,295.91 | 44,314,883.50 | <0.001 | 99.1 | 55,848,149.88 | 55,507,149.30 | 0.780 |
Rt pass HS | 86.138 | 85.631 | 0.211 | 92.6 | 86.286 | 86.324 | 0.902 |
GDP per capita | 2,753,400.11 | 2,816,644.81 | 0.481 | 90.7 | 2,731,272.41 | 2,727,414.55 | 0.923 |
Balancing Conditions (Rubin statistics) | |||||||
B | 19.0 | ||||||
R | 0.83 | ||||||
Panel B—Common support of matching between treated and untreated groups | |||||||
Out of Support | Common Support | Total | % of Participation | ||||
Control | 0 | 606 | 606 | 100 | |||
Treated | 92 | 1509 | 1601 | 94.25 | |||
Total | 92 | 2115 | 2207 | 95.83 |
Variables | DID | PSM-DID | Placebo Regression | |||
---|---|---|---|---|---|---|
Log Stroke Expenditure * | Standard Error | Stroke Expenditure * | Standard Error | Hosp for Hypertension | Standard Error | |
HGP | −0.1793 b | 0.089 | −0.1785 b | 0.089 | 0.1447 | −2.302 |
Propensity Score | - | - | 1.228 | −1.051 | −7.631 | 30.65 |
>40 years/10,000 inhab | 0.002 a | <0.001 | 0.002 a | 0.001 | −0.011 | 0.019 |
Log no. of doctors | −0.093 | 0.065 | −0.118 c | 0.067 | −0.442 | 0.993 |
No. of hosp. Beds. | −0.000 | 0.001 | −0.001 | 0.001 | 0.005 | 0.017 |
Presence of NASF-AB | −0.014 | 0.086 | 0.088 | 0.111 | −2.784 | −3.115 |
Total Health Expenditure | 0.000 a | <0.001 | <0.001 a | 0.000 | −0.000 b | <0.001 |
Rt pass high school | 0.014 a | 0.005 | 0.014 a | 0.005 | −0.024 | 0.122 |
GBP per capita | 0.000 a | <0.001 | <0.001 a | <0.001 | <0.001 | <0.001 |
outlier | −7.208 a | 0.140 | −7.176 a | 0.145 | 0.760 | −1.890 |
Time of Exposure | ||||||
1st Year | −0.436 c | 0.251 | −0.346 | 0.258 | −1.780 | −8.426 |
2nd Year | −0.487 a | 0.233 | −0.408 c | 0.237 | −1.328 | −7.388 |
3rd Year | 0.108 | 0.195 | 0.174 | 0.201 | −1.324 | −6.066 |
4th Year | 0.366 b | 0.168 | 0.416 b | 0.173 | −0.695 | −4.713 |
5th Year | 0.222 | 0.148 | 0.268 c | 0.153 | −2.372 | −3.842 |
6th Year | −0.034 | 0.110 | 0.003 | 0.116 | −1.719 | −2.491 |
7th Year | 0.092 | 0.0913 | 0.121 | 0.097 | −0.874 | −1.588 |
8th Year | −0.452 | 0.411 | −0.581 | 0.421 | 0.140 | 11.155 |
Constant | 0.962 | 1.842 | 0.962 | 1.842 | 65.03 | 56.18 |
R2 | 0.855 | 0.855 | 0.134 |
Stroke | Coeficiente | Standard-Error | z | p-Value | 95% Confidence Interval | |
---|---|---|---|---|---|---|
lead2 | 0.252 | 0.197 | 10.28 | 0.201 | −0.134 | 0.64 |
lead1 | 0.081 | 0.193 | 0.42 | 0.675 | −0.298 | 0.461 |
treat | −0.023 | 0.191 | −0.12 | 0.904 | −0.398 | 0.352 |
lag1 | −0.45 | 0.191 | −20.35 | 0.019 | −0.825 | −0.075 |
lag2 | −0.596 | 0.191 | −30.12 | 0.002 | −0.971 | −0.222 |
_cons | 7.95 | 0.128 | 61.86 | <0.001 | 7.703 | 8.207 |
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da Guarda, F.R.B. Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil. Int. J. Environ. Res. Public Health 2022, 19, 12174. https://doi.org/10.3390/ijerph191912174
da Guarda FRB. Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil. International Journal of Environmental Research and Public Health. 2022; 19(19):12174. https://doi.org/10.3390/ijerph191912174
Chicago/Turabian Styleda Guarda, Flávio Renato Barros. 2022. "Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil" International Journal of Environmental Research and Public Health 19, no. 19: 12174. https://doi.org/10.3390/ijerph191912174