Post-COVID-19 recovery of elective surgery in Brazil: a nationwide ecological analysis of access, regional inequalities, and health system resilience
1
René Rachou Institute, Fundação Oswaldo Cruz (Fiocruz), Belo Horizonte, Brazil
2
School of Business Administration of Sao Paulo, Getúlio Vargas Foundation, São Paulo, Brazil
3
Institute of Political Science, Universidade de Brasília, Brasília, Brazil
4
Research Center in Political Science, University of Minho, Braga, Portugal
Popul. Med. 2026;8(Supplement 1):A1700
ABSTRACT
INTRODUCTION:
The COVID-19 pandemic severely disrupted elective care, creating significant backlogs that continue to strain health systems globally. In Brazil, the National Waiting List Reduction Program (Programa Nacional de Redução das Filas, PNRF) was one of the initiatives launched by the Federal Government to address these delays. This study assesses the PNRF's impact on restoring access to inpatient surgical care within the Brazilian Unified Health System (SUS).
METHODS:
We conducted an ecological study using publicly available data from the Hospital Information System (SIH/DATASUS) spanning 2018 to 2024, integrated with municipal indicators. We compared surgical rates between the pre-pandemic (January 2018 January 2020) and post-pandemic (May 2022–December 2024) periods to identify trends and determinants of recovery.
RESULTS:
Post-pandemic growth in surgical volume was substantial and widespread, ranging from 50% across states. Increases were most pronounced among residents of municipalities with lower socioeconomic status and fewer local health resources. A "catch-up" dynamic was observed, where municipalities with lower pre-pandemic surgical volumes experienced greater growth, likely driven by expanded local service provision. Additionally, areas with a lower pandemic disruption showed greater resilience and faster recovery.
CONCLUSIONS:
The combination of a national push to restore elective care with renewed federal steering effectively supported a "catch-up" in underserved regions and promoted better regionalization of care. While the program successfully jumpstarted recovery, the critical challenge remains transforming this momentum into a sustainable model for specialized care delivery that ensures long-term equity and access.
The COVID-19 pandemic severely disrupted elective care, creating significant backlogs that continue to strain health systems globally. In Brazil, the National Waiting List Reduction Program (Programa Nacional de Redução das Filas, PNRF) was one of the initiatives launched by the Federal Government to address these delays. This study assesses the PNRF's impact on restoring access to inpatient surgical care within the Brazilian Unified Health System (SUS).
METHODS:
We conducted an ecological study using publicly available data from the Hospital Information System (SIH/DATASUS) spanning 2018 to 2024, integrated with municipal indicators. We compared surgical rates between the pre-pandemic (January 2018 January 2020) and post-pandemic (May 2022–December 2024) periods to identify trends and determinants of recovery.
RESULTS:
Post-pandemic growth in surgical volume was substantial and widespread, ranging from 50% across states. Increases were most pronounced among residents of municipalities with lower socioeconomic status and fewer local health resources. A "catch-up" dynamic was observed, where municipalities with lower pre-pandemic surgical volumes experienced greater growth, likely driven by expanded local service provision. Additionally, areas with a lower pandemic disruption showed greater resilience and faster recovery.
CONCLUSIONS:
The combination of a national push to restore elective care with renewed federal steering effectively supported a "catch-up" in underserved regions and promoted better regionalization of care. While the program successfully jumpstarted recovery, the critical challenge remains transforming this momentum into a sustainable model for specialized care delivery that ensures long-term equity and access.
| eISSN: | 2654-1459 |
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