Regional differences and costs of physical therapy procedures in Brazil's Unified Health System, 1995 to 2008

Objective. Describe the ambulatory physical therapy treatments provided by the Unified Health System (SUS) in Brazil with regard to their geographical distribution, costs, types of procedure, and types of provider. Methods. Data from the SUS Information Technology Department (DATASUS) were utilized, drawing from the period from 1995 to 2008, which included the quantity and the value of the procedures approved for payment by the Secretariats of Health and the quantity and value of the procedures presented for payment. The treatment coefficients (CoA) were calculated by dividing the number of treatments in a particular year and region by the estimated population of that region in that year. Results. The CoA in Brazil in 2008 was 0.19 and the North and Center-West regions presented the lowest coefficients (0.13 and 0.10, respectively). Between 1995 and 2007 there was an increase in the national treatment coefficient of 33.7%, with the North region showing the largest increase, 143.8%; the Center-West 62.1%, and the Northeast 56.1%. Treatment for motor disorders was the most widely performed procedure (61.8%), and the values of payments approved were lower than those presented by the managers of the services in 2008 (10.4%). Private for-profit establishments provided 44.5% of the physical therapy treatments paid for by the SUS in 2008. Municipal establishments accounted for 26.6% of the treatments, and federal establishments for only 0.9%. Between 1995 and 2007, the quantity of treatments offered by municipal establishments increased 278.7%. Conclusions. It was observed that the provision of ambulatory physical therapy treatment by the SUS remains small and geographically unequal, although less-developed regions showed a larger increase in the CoA. The SUS remunerates inadequately the physical therapy services provided and continues to do so, in large part, by means of agreements with private establishments.