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COVID Index: Vulnerability of the Hospital Structure in Brazilian Microregions

Many developing countries, such as Brazil, have highly unequal health systems across their regions. The pandemic of the new coronavirus (COVID-19) brought an additional challenge, as hospital structures equipped with doctors, intensive care units (ICUs) and respirators are not available to a sufficient extent in all regions. We create a COVID Index to verify whether the hospital structures in 27 states and 543 Brazilian microregions are adequate to deal with COVID-19 and to verify whether public policies were implemented in the right direction. We use Data Envelopment Analysis (DEA) and advance with the metafrontier technique. The results indicate that hospital structures in the poorest microregions (North and Northeast) were the most vulnerable, although the peak of COVID-19 occurred in the richest microregions (Sao Paulo) in Southeast Brazil. The Southeast states could relocate hospital resources or even patients between their regions. However, relocation was not possible in many states in the Northeast, as the health system poorly assisted the interior of these states. These findings reveal that the heterogeneity of microregions’ hospital structures follows the patterns of socioeconomic inequalities. We conclude that it is easier for the wealthier regions to reallocate hospital resources internally than for the poorest regions. During the pandemic, Brazil’s policy intervention did not seem adequate. By using the COVID Index, policymakers and hospital managers have straightforward information to decide which regions must receive new investments and reallocate underutilized resources.