Impact of health conditions on non-medical costs: a time series analysis of disability insurance and hospital medical costs in Brazil (2010-2019)

Disability insurance represents a significant economic burden within Brazil's social security system, yet long-term cost trends across disease groups remain understudied, hindering informed prevention and management strategies. Hospital costs, which account for approximately 40% of direct healthcare expenses, were selected as a comparative reference to contextualize the economic burden of disability insurance. This study analyzes long-term cost trends of newly granted disability insurance by disease groups in Brazil, comparing them to public health system hospitalization expenses. This ecological time series study applied the inflection point regression model and Annual Average Percentage Change (AAPC) analysis, utilizing open-access federal government datasets. Annual rates and costs of disability insurance and hospitalizations were examined, categorized by International Classification of Diseases, 10th Revision (ICD-10) groups, and standardized per insured individuals and the general population. Between 2010 and 2019, the rate of temporary disability insurance granted (406 per 10,000 insureds) was 94% higher than permanent disability insurance (24 per 10,000), with women showing slightly higher rates but men incurring higher costs. The overall annual average rate of granted disability insurance (430 per 10,000 insureds) and its costs (BRL 5,084 per 100 insureds) were lower than those of hospitalizations (525 per 10,000 and BRL 5,870 per 100 Brazilians, respectively). Disabilities due to injuries, musculoskeletal disorders, and mental health problems had the highest rates (126, 89, and 40 per 10,000 insureds, respectively) and costs (BRL 1,455, 1,076, and 533 per 100 insureds, respectively). Neoplasms showed the only increasing trend in granted rates (AAPC 2.5%). The cost growth of granted disability insurance (AAPC 6.2%) was twice that of hospitalization costs (AAPC 2.9%), with disability insurance costs surpassing hospitalization expenses by 2018. Although most disease groups exhibited stable or declining trends in granted rates, costs increased across nearly all conditions. The rising costs of disability insurance in Brazil highlight the growing economic burden of non-medical expenses and the need for evidence-based policies focused on prevention, management, and the sustainability of the social security system.