Socicitation Rate in ICU during the COVID-19 Pandemic: Benford's Law in the Cariri Health Region

Authors

DOI:

https://doi.org/10.14295/idonline.v20i81.4396

Keywords:

Benford's Law, COVID-19, ICU, Health regulation, Cancellations, Family refusal, Collective panic, Upcoding, Hospital financing, Health audit , Ceará, Cariri, Pandemic

Abstract

Introduction: The COVID-19 pandemic placed unprecedented pressure on health systems worldwide, generating an objective health crisis alongside documented collective panic, media-amplified nocebo effects, and financial incentives potentially favoring diagnostic upcoding. On February 16, 2021, Brazil's Ministry of Health changed the ICU financing model from a fixed payment per enabled bed — regardless of occupancy — to payment per effectively occupied bed (R$1,600/bed-day). Objective: To analyze 2,602 ICU transfer requests (February–September 2021) in the Cariri health region, Ceará, Brazil, under two perspectives: Benford's Law application to detect registration inconsistencies; and analysis of 921 cancelled requests (35.4%) as markers of collective panic, family refusal, and demand distortion. Methods: Chi-square (χ²) and Mean Absolute Deviation (MAD) tests were applied to first digits of daily requests (n=203 observation-days), waiting times by outcome (n=2,602), and multilevel comparative analysis with COVID-19 epidemiological data. Results: 1,681 requests were fulfilled (64.6%) and 921 cancelled (35.4%). Cancelled requests showed significantly older patients (68.9 vs. 59.0 years; p<0.001); 48.8% of patients aged 80+ had requests cancelled. The cancellation peak was May 2021 (46.2%) — coinciding with the peak of social panic, not the epidemiological peak. Benford's Law on daily requests showed severe non-conformity (MAD=0.0399; χ²=85.76; p<0.0001); paradoxically, actual waiting times showed excellent conformity (MAD=0.0060). Conclusion: Findings suggest overlapping phenomena: collective panic generating disproportionate demand with high family refusal rates in elderly patients; upcoding favored by the shift to production-based reimbursement; and artificial fragmentation of requests generating the statistical signature identified by Benford's Law. Simultaneously, the pay-per-occupied-bed model — combined with beds fully released through a decentralized regulation system — may constitute one of the solutions to the historically low ICU occupancy rates in the public health system, by aligning financial incentives with actual resource utilization.

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Author Biographies

Maria Cléa de Sá Roriz Neves, Hospital Regional do Cariri, Juazeiro do Norte, Ceará, Brasil.

Graduada em Medicina pela Faculdade de Medicina de Juazeiro do Norte (FMJ). Residência Médica em Cirurgia Geral, João Pessoa - PB. Diretora Técnica do Hospital Regional do Cariri (Juazeiro do Norte - CE).

Hermes Melo Teixeira Batista, Universidade Estadual do Ceará (UECE). Quixeramobim, Ceará. Brasil.

Mestrado e Doutorado em Ciências da Saúde pela Faculdade de Medicina do ABC, São Paulo. Servidor público da Secretaria de Saúde do Estado do Ceará, Estando como Coordenador Médico do Complexo Regulador do Cariri. Médico anestesiologista do Hospital Regional do Cariri e Médico anestesiologista do HUJB-EBSERH. Possui Título de Especialista em Anestesiologia pela Sociedade Brasileira de Anestesiologia desde 2004. Membro afiliado da European Society of Anesthesiology. Superintendência Regional de Saúde do Cariri / SRSUL – Juazeiro do Norte/CE. . UECE/FUNECE – Quixeramobim/CE. 

Rondinelle Alves do Carmo, Universidade Estadual do Ceará (UECE). Quixeramobim, Ceará. Brasil.

Graduação em Farmácia pela Universidade Federal do Ceará (UFC). Pós Graduação em Hematologia Clínica pela UFC e Mestrado em Gestão de Tecnologia e Inovação em Saúde pelo Hospital Sírio Libanês. Especialista em Gestão em Saúde pela Escola Nacional de Saúde Pública e Gestão de Assistência Farmacêutica pela Universidade Federal de Santa Catarina. UECE/FUNECE – Quixeramobim/CE;

Tereza Cristina Mota de Souza Alves, Universidade Estadual do Ceará (UECE). Quixeramobim, Ceará. Brasil.

Cirurgiã-dentista. Mestra em Gestão em Saúde - Universidade Estadual do Ceará (UECE). Especialista em Saúde Pública (UECE). Especialista em Gestão de Redes de Atenção à Saúde - Fundação Oswaldo Cruz (FIOCRUZ). Especialista em Gestão de Políticas de Saúde informadas por evidências - Instituto Sírio Libanês. Atualmente, cursando Especialização em Excelência Operacional em Saúde - Hospital Israelita Albert Einstein. É superintendente da Região de Saúde do Cariri. UECE/FUNECE – Quixeramobim/CE.

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Published

2026-05-31

How to Cite

Neves, M. C. de S. R., Batista, H. M. T., Carmo, R. A. do, & Alves, T. C. M. de S. (2026). Socicitation Rate in ICU during the COVID-19 Pandemic: Benford’s Law in the Cariri Health Region. ID on Line. Revista De Psicologia, 20(81), 49–68. https://doi.org/10.14295/idonline.v20i81.4396

Issue

Vol. 20 No. 81 (2026)

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Artigos

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