An Infrastructure to Support the Visual Analysis of Data from the Brazilian Public Health System

An Infrastructure to Support the Visual Analysis of Data from the Brazilian Public Health System

Full First Author1*, Full Second Author2, Full Third Author1, 2

1 The first affiliation and address, including city, state, nationality.

2 The second affiliation and address.

* Corresponding author. Tel.: ???; email: ???

Manuscript submitted January 10, 2014; accepted March 8, 2014.

doi: ???

Abstract: Understanding how Brazilian health units have been reimbursed due to services provided on behalf of the Brazilian Public Unified Health System (SUS) is not a simple task. It requires the analysis of a myriad of data and hampers the identification of flaws as well as improvement opportunities regarding the budget application in the context of health public services. In this paper, we propose an infrastructure to support the visual analysis of data from the Brazilian Public Unified Health system focused on data related to services provided by health units to the Brazilian Public Unified Health System (SUS). As a result of this support, we present an analysis scenario where we discuss the performance of health units from the Brazilian Northeast region in a specific time interval.

Key words: Brazilian Public Unified Health System; Health Information Systems; Information Visualization.

1. Introduction

Public health plays an important role for citizens and has drawing attention of both policymakers and the public at large. Concerns about gaps in both the availability and quality of public health services have hit the headlines in response to both new and persistent health risks [1]. For this reason, decision makers and practitioners should be careful about the allocation, management, and administration of public health resources [1].

The effectiveness of health care expenditure is a worldwide concern and this is not an exception in Brazil [3]. The Brazilian citizens expect from the public health system an appropriate use of out-of-pocket health expenses. In 1988, within the new Constitution, the Brazilian Unified Health System (SUS) was created by the Brazilian Ministry of Health to offer free health care to the population, based on three pillars: universal coverage, integral health care and equity [3]. In 1991 was created the Information Systems Department of SUS called DATASUS to support the Ministry of Health to develop and maintain software systems to process data related to the health domain. The Table 1 present the software systems maintained by DATASUS. The Decentralized health unit Information System (SIHD) registers the health unit admissions. Data related to these admissions are monthly informed by the health units that provide services to citizens on behalf of SUS^[1].  The SUS health unit Information System (SIHSUS) supports the management of the medical billing invoices sent by health units from all parts of the country that provide services on behalf of SUS^[2]. This software system deals with invoices related to health unit stays costs that is the focus of analysis of this paper. The main reason for this choice is the considerable amount of data related to this topic and the corresponding specificities. The system called TABWIN has the goal to support health unit staff to analyze data. It allows the tabulation of dBase files (DBF) that constitute the main components of SUS information systems. TABWIN manipulates different types of information such as health unitization data, mortality, population. Users can download data from the site of DATASUS.

Table 1. Brazilian Ministry of Health Systems related to Medical Billing Invoice

Goal	Application	Database	Local/ Network
Medical Billing Invoice	Decentralized health unit Information System (SIHD). SUS health unit Information System (SIHSUS).	Firebird ORACLE	Local Network
Validated Medical Billing Invoice	TABWIN.	DBF/Text	Local
Supporting Parameters	National Registry of Health Institutions (CNES). SUS Medical Procedures and Medicine System (SIGTAP).	Firebird/Text Text	Local Local

There are worldwide initiatives to present data related to how countries have provisioned health-care to their citizens ^[3][4][5]. For example, the World Health Organization provides worldwide data related to different health themes. However, there is no specific report to present worldwide health-care expenditure by country ^[6]. To the best of our knowledge, in the Brazilian scenario, there is no software suite available to support citizens to monitor SUS expenditures. The software systems provided by the Ministry of Health are not integrated with one another and the way data is available requires a thorough knowledge of the data set structure and organization.  To fill this gap, this paper proposes an approach to support the visual analysis of data from the Brazilian Public Health System.

This paper is organized as follows. Section 2 contextualizes data available from the Brazilian Public Unified Health System. Section 3 presents the advantages of information visualization as a tool for data analysis. the visual approach to analyze data. Section 4 describes the proposed approach to analyze the Brazilian Health Data. illustrates the use of the visual infrastructure with data provided by SUS. Section 5 illustrates the use of the visual approach to analyze the Brazilian Health Data. Section 6 presents conclusions and future work.

1. Data Available from the Brazilian Public Unified Health System

The vast majority of Brazilian citizens depend on the public health system. For this reason, the analysis of data related to this topic deserves special attention. To contextualize the analysis, we created a process flow as conveyed in Figure 1. It was adapted from the Portuguese version of the health unit Information System Guide from   the Brazilian Unified Health System (SUS) ^[7]. The process describes the steps required to approve the medical billing invoice sent from the health units to the approval of the Brazilian Ministry of Health. It begins when the health units' staff access a local DATASUS System called SIHD (described in Table 1) daily to register data to generate the medical billing invoices. The next step is the validation of the invoices by this local system and the monthly generation of files comprised of data related to the aforementioned invoices. This text file is the input to a second level of validation process in charge of the Health State Department from the State that the health unit is located. In case the validation is not successful, the invoice is sent back to the health unit. On the other hand, the validated invoices are monthly sent to the Ministry of Health to be processed. The Ministry of Health then publishes the decision regarding the invoices approval or not in the web site ^[8][9]. This process flow involves different systems and different actors such as the health unit staff, the Health State Department and the Ministry of Health staff.