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Inequalities in Technical Brazilian Health Workforce August/2009

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Inequalities in Technical Brazilian Health Workforce August/2009. Alexandra Almeida Mônica Vieira Arlinda Moreno Márcio Candeias. Outline. Who We Are The Research Project Data Base The Health Sector Some Brazilian Health Workforce Idiosyncrasies The Problem - PowerPoint PPT Presentation
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Inequalities in Technical Brazilian Health Workforce August/2009 Alexandra Almeida Mônica Vieira Arlinda Moreno Márcio Candeias
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Page 1: Inequalities in  Technical  Brazilian Health Workforce August/2009

Inequalities in Technical

Brazilian Health Workforce

August/2009

Alexandra AlmeidaMônica VieiraArlinda MorenoMárcio Candeias

Page 2: Inequalities in  Technical  Brazilian Health Workforce August/2009

2

Outline

1. Who We Are2. The Research Project3. Data Base4. The Health Sector5. Some Brazilian Health Workforce Idiosyncrasies6. The Problem7. The Objective of this Study8. A Statistical Help9. Reading the Model10. Results and Conclusions11. Further Work

Page 3: Inequalities in  Technical  Brazilian Health Workforce August/2009

3

Who We Are

Brazilian Ministry of Health

Oswaldo Cruz Foundation

Polytechnic Health School Joaquim Venâncio

Work Laboratory and Health Care

Professional Education

Brazilian Health Technicians Observatory

GOAL: Produce and share knowledge about the technical Brazilian workers aiming the health workforce development.

Page 4: Inequalities in  Technical  Brazilian Health Workforce August/2009

4

The Research Project

Works in the construction of occupational categories that represents the general Brazilian Health sector; identication of the technical workforce analysing the qualification, trends, and the characteristics of these workers.

However...

How can we infer about the technicians workers in Brazilian Health Sector?

Page 5: Inequalities in  Technical  Brazilian Health Workforce August/2009

5

The Research Project

‒ The first (and macro) approach to study this workers was done considering the AMS (Medical-Sanitary Assistance)

Survey produced by IBGE (Brazilian Institute of Geography and Statistics).

Investigates all the health institutions existing in the country which provide individual or collective health assistance services.

Page 6: Inequalities in  Technical  Brazilian Health Workforce August/2009

6

The Research Project

‒ The AMS exploratory analyses brings some interesting information:

The high school jobs are concentrated in Brazil southeast region,

The elementary jobs are concentrated in Brazil northeast region.

A natural extension is studying the health

workers, instead of establishments.

Page 7: Inequalities in  Technical  Brazilian Health Workforce August/2009

7

Data Base

PNAD: National Household Sample Survey

Produced by IBGE (Brazilian Institute of Geography and Statistics).

Represents a valuable instrument to the evaluation of the socio-economic and demographic reality in the country.

Brings general attributes (self-declared) of the Brazilian population like

Occupation Schooling Labor details …

Page 8: Inequalities in  Technical  Brazilian Health Workforce August/2009

8

The Health Sector

Brazilian Health

Occupations

AdministrativeMedical/Hospital

EquipmentSupport

Specific Health

Other

Page 9: Inequalities in  Technical  Brazilian Health Workforce August/2009

9

Some Brazilian Health Workforce Idiosyncrasies

Gender Distribution (%)

38.6

25.1

43.1

58.9

23.0

61.4

74.9

56.9

41.1

77.0

0 25 50 75 100

Other Occupations

Especif ic HealthOccupations

Support Occupations

Medical/HospitalEquipment

Occupations

AdministrativeOccupations

Male Female

Job Sector Distribution (%)

70.9

44.6

59.4

73.3

74.9

29.1

55.4

40.6

26.7

25.1

0 25 50 75 100

Other Occupations

Especif ic HealthOccupations

Support Occupations

Medical/HospitalEquipment

Occupations

AdministrativeOccupations

Private Public

Page 10: Inequalities in  Technical  Brazilian Health Workforce August/2009

10

Some Brazilian Health Workforce Idiosyncrasies

Worked Hours per Week (%)

1.1

22.0

54.8

11.7 10.4

0.5

21.9

46.9

16.1 14.6

2.1

20.4

43.8

20.4

13.4

2.8

29.5

34.8

10.9

22.0

1.1

17.9

46.7

21.2

13.0

0

20

40

60

80

100

Less than 14 horas 15 to 39 hours 40 to 44 hours 45 to 48 hours More than 49 hours

Administrative Occupations Medical/Hospital Equipment OccupationsSupport Occupations Especific Health OccupationsOther Occupations

Page 11: Inequalities in  Technical  Brazilian Health Workforce August/2009

11

The Problem

‒ The variable occupation was constructed based in the Brazilian Occupations Classification (CBO), a Brazilian adaptation to the International Standard Classification of Occupations (ISCO).

‒ Some PNAD occupations in health: Nurses professionals Nursing technicians Chemist Chemical Technicians Biologist and related (???)

Page 12: Inequalities in  Technical  Brazilian Health Workforce August/2009

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The Objective of this Study

Identify the technicians health workers

1. Groupping occupations by similarities

2. Selecting pairs of occupations where the tecnicians and professionals are not fuzzy.

3. Modelling (statistically) the characteristics that delimits the workers as technicians and professionals.

Page 13: Inequalities in  Technical  Brazilian Health Workforce August/2009

13

A Statistical Help

‒ We constructed occupations clusters for the “Especific Health Occupation” group, and select the pairs:

Chemist and related technicians Pharmaceutic and related technicians Nursing and related technicians Phisiotherapy and related technicians Odontologist and related technicians

Page 14: Inequalities in  Technical  Brazilian Health Workforce August/2009

14

A Statistical Help

Pairs’ Descriptive Statistics

Professionals Technicians

Gender Male 179 49.7% 181 50.3% Female 445 30.3% 1023 69.7% Schooling Elementary School 5 10.6% 42 89.4% High School 20 2.3% 832 97.7% Graduate 509 78.4% 140 21.6% Master or Doctor 28 96.6% 1 3.4% Job Sector Private 175 24.5% 540 75.5% Public 169 22.5% 582 77.5%

Less than 14 hours 21 51.2% 20 48.8% 15 to 39 hours 181 31.7% 390 68.3% 40 to 44 hours 224 34.7% 421 65.3% 45 to 48 hours 60 26.9% 163 73.1%

Worked HoursPer Week

49 hours or more 137 39.5% 210 60.5%

Professionals Technicians

2030

4050

6070

Age

Professionals Technicians

020

0040

0060

0080

00

Income

Page 15: Inequalities in  Technical  Brazilian Health Workforce August/2009

15

A Statistical Help

‒ In order to model/predict the relationship between workers characteristics to their actual worker position we use the bernoulli model,

‒ The bernoulli probability function is expressed as:

where π is the probability of success, y corresponds to success or failure.

1,0;)1()( 1 yyYP yy

Page 16: Inequalities in  Technical  Brazilian Health Workforce August/2009

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A Statistical Help

‒ The logit function was chosen by the AIC and BIC criteria.

‒ The variables age, gender and worked hours per week were not statistically significant, and do not belong to the final model.

In gray, the basal category

Coefficients Estimate Std. Error z value Pr(>|z|)

Intercept 2.0349 0.5409 3.7620 0.0002

Schooling: Elementary School - - - -

Schooling: High School 1.8733 0.5894 3.1780 0.0015

Schooling: Graduate -2.5597 0.5550 -4.6120 0.0000

Schooling: Master or Doctor -4.3159 1.1795 -3.6590 0.0003

Income -0.0004 0.0001 -3.2010 0.0014

Job Sector: Private - - - -

Job Sector: Public 0.6502 0.2054 3.1660 0.0015

Page 17: Inequalities in  Technical  Brazilian Health Workforce August/2009

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A Statistical Help

Goodness-of-Fit

Hosmer and Lemeshow Test

Observed Expected Observed Expected1 102 104.25 27 24.75 1292 97 88.46 30 38.54 1273 71 74.71 53 49.29 1244 17 21.46 107 102.54 1245 3 3.07 114 113.93 1176 3 3.04 122 121.96 1257 2 2.82 123 122.18 1258 5 2.12 129 131.88 1349 1 1.65 124 123.35 125

10 2 1.41 117 117.59 119

Professionals TechniciansTotal

28

10

1

22 ~

/1

)(

i iii

iiHL nEE

EOG

Where:ni is the number of observations in the ith groupOi is the observed number of cases in the ith groupEi is the expected number of cases in the ith group

P-value: 31.78%

Page 18: Inequalities in  Technical  Brazilian Health Workforce August/2009

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A Statistical Help

Residual Analysis

Studentized Residuals

Studentized Residuals

Fre

qu

en

cy

-3 -2 -1 0 1 2 3

02

00

40

06

00

80

0

-3 -2 -1 0 1 2 3

-3-2

-10

12

3

Normal Q-Q Plot

Standard Normal Quantile

De

via

nce

Normal Q-Q PlotNormal Q-Q PlotNormal Q-Q Plot

Page 19: Inequalities in  Technical  Brazilian Health Workforce August/2009

19

A Statistical Help

‒ In order to evaluate the predictive power, we calculate the confusion matrix, and:

Total rate of correct classification: 88.3% Percentage of professionals well classified: 93.1% Proportion of technicians well classified is 86.8%.

Page 20: Inequalities in  Technical  Brazilian Health Workforce August/2009

20

Reading the Model

Scholling‒ Workers with high school as higher level have 6 times

more chances to be technicians than those who have just the elementary school

‒ The graduated workers have 13 times more chances to be a professional

‒ Master/doctor workers are 75 times more likely to be professionals than those with elementary school.

Job Sector‒ The workers in public institutions have approximately 2

times more chances to occupy a technical position.

Page 21: Inequalities in  Technical  Brazilian Health Workforce August/2009

21

Results and Conclusions

‒ Imbalances: 14% of the workers in technicians occupation are graduated or

have a master/doctor;

66% of the workers in technicians occupations work more than 40 hours per week;

‒ Study Benefits: A right work insertion based on the schooling has a larger impact

in public health sector. The multiple work links dimishes the income impact (estimated

coefficient: -0.0004); The model allow us to identify the technicians with

graduation, master/doctor Estimating the Brazilian health technical workforce amount.

Page 22: Inequalities in  Technical  Brazilian Health Workforce August/2009

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Further Work

‒ Extend the cluster analysis to the others 4 health occupation groups (managers, medical/hospital equipment, support and others),

‒ Sophisticate the model to cover all health occupations groups.

‒ Explore all the available years of the survey, understanding the trend of the qualification and work insertion of this workforce.

Page 23: Inequalities in  Technical  Brazilian Health Workforce August/2009

Inequalities in Technical Brazilian Health Workforce

ISI, August/2009

Alexandra AlmeidaMônica VieiraArlinda MorenoMárcio Candeias

Thanks!!!Polytechnic Health School Joaquim Venâncio:

www.epsjv.fiocruz.br

International Network of Health Technicians Eucation:

www.rets.epsjv.fiocruz.br


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