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Galárraga O, Quijano-Ruiz A, Faytong-Haro M. The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador. WORLD DEVELOPMENT 2024; 181:106659. [PMID: 38911668 PMCID: PMC11192489 DOI: 10.1016/j.worlddev.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.
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Affiliation(s)
| | - Alonso Quijano-Ruiz
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, China
| | - Marco Faytong-Haro
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- Pennsylvania State University, State College, PA, USA
- Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
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Wichmann B, Wichmann R. COVID-19 and Indigenous health in the Brazilian Amazon. ECONOMIC MODELLING 2022; 115:105962. [PMID: 35874451 PMCID: PMC9290384 DOI: 10.1016/j.econmod.2022.105962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/07/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
We test whether the COVID-19 pandemic has an ethnicity-differentiated (Indigenous vs non-Indigenous) effect on infant health in the Brazilian Amazon. Using vital statistics data we find that Indigenous infants born during the pandemic are 0.5% more likely to have very low birth weights. Access to health care contributes to health gaps. Thirteen percent of mothers travel to deliver their babies. For traveling mothers, having an Indigenous baby during the pandemic increases the probability of very low birth weight by 3%. Indigenous mothers are 7.5% less likely to receive adequate prenatal care. Mothers that travel long distances to deliver their babies and give birth during the pandemic are 35% less likely to receive proper prenatal care. We also find evidence that the pandemic shifts medical resources from rural to urban areas, which disproportionately benefits non-Indigenous mothers. These results highlight the need for policies to reduce health inequalities in the Amazon.
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Affiliation(s)
- Bruno Wichmann
- Department of Resource Economics & Environmental Sociology, College of Natural and Applied Sciences, University of Alberta, 503 General Services Building, Edmonton, AB T6G-2H1, Canada
| | - Roberta Wichmann
- Brazilian Institute of Education, Development and Research - IDP, Economics Graduate Program, SGAS Quadra 607, Modulo 49, Via L2 Sul, Brasilia, DF CEP 70.200-670, Brazil
- World Bank, SCES Trecho 03, Lote 05, Ed. Polo 8, S/N, Brasilia, DF CEP 70200-003, Brazil
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Kinge JM, Grytten J. The impact of primary care physician density on perinatal health: Evidence from a natural experiment. HEALTH ECONOMICS 2021; 30:2974-2994. [PMID: 34498332 DOI: 10.1002/hec.4426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
We examined the impact of primary care physician density on perinatal health outcomes in Norway. From 1992 and onwards, primary care physicians who chose to work in selected remote municipalities were given an annual reduction in their student loan. This reduction, combined with increased supply of physicians, led to an increase in the density of primary care physicians in these selected municipalities. Our register-based population study showed that this increase in physician density significantly improved perinatal health in terms of fewer fetal deaths and increased birth weight. The richness of the data allowed us to perform several robustness tests.
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Affiliation(s)
- Jonas Minet Kinge
- Norwegian Institute of Public Health and University of Oslo, Oslo, Norway
| | - Jostein Grytten
- University of Oslo, Norway and Akershus University Hospital, Lørenskog, Norway
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Castro M, Mattos E, Patriota F. The effects of health spending on the propagation of infectious diseases. HEALTH ECONOMICS 2021; 30:2323-2344. [PMID: 34247434 DOI: 10.1002/hec.4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
We explore the discontinuity in the allocation of the main federal grant to Brazilian municipalities to identify the local effects of health spending and the spillovers into the bordering jurisdictions. Fiscal reactions are asymmetric: small neighbors reduce health spending, while we do not find a significant budgetary response in the largest neighbor. Our results suggest a reduction in the spread of infectious diseases in the neighbors, with fewer residents hospitalized with gastrointestinal infections. In addition, the elderly demand less hospitalization in the largest bordering jurisdictions due to respiratory infectious diseases. Finally, we find a direct and significant reduction in infant mortality, consistent with the observed pediatricians' increase, while the spillover effects on neighbors' mortality rates are not conclusive.
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Affiliation(s)
- Marcelo Castro
- Federal University of Uberlândia (UFU), Campus UFU Santa Mônica, Uberlândia, Minas Gerais, Brazil
| | - Enlinson Mattos
- São Paulo School of Economics, Fundação Getúlio Vargas, São Paulo, São Paulo, Brazil
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Özçelik EA, Massuda A, McConnell M, Castro MC. Assessing the performance of beneficiary targeting in Brazil's More Doctors Programme. Health Policy Plan 2021; 36:149-161. [PMID: 33448298 PMCID: PMC7996646 DOI: 10.1093/heapol/czaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Many countries employ strategies that rest on the use of an explicitly defined set of criteria to identify underserved communities. Yet, we know relatively little about the performance of community-level targeting in large-scale health programmes. To address this gap, we examine the performance of community targeting in the More Doctors Programme (MDP). Our analysis covers all 5570 municipalities in the period between 2013 and 2017 using publicly available data. We first calculate the rate at which vulnerable municipalities enrolled in the MDP. Next, we consider two types of mistargeting: (1) proportion of vulnerable municipalities that did not have any MDP physicians (i.e. under-coverage municipalities) and (2) proportion of MDP enrolees that did not fit the vulnerability criteria (i.e. non-target municipalities). We found that almost 70% of vulnerable municipalities received at least one MDP physician between 2013 and 2017; whereas non-target municipalities constituted 33% of beneficiaries. Targeting performance improved over time. Non-target municipalities had the highest levels of socioeconomic development and greater physician availability. The poverty rate among under-coverage municipalities was almost six times that in non-target municipalities. Under-coverage municipalities had the lowest primary care physician availability. They were also smaller and more sparsely populated. We also found small differences in the political party alignments of mayors and the President between under-coverage and non-target municipalities. Our results suggest that using community-level targeting approaches in large-scale health programmes is a complex process. Programmes using these approaches may face substantial challenges in beneficiary targeting. Our results highlight that policymakers who consider using these approaches should carefully study various municipal characteristics that may influence the implementation process, including the level of socioeconomic development, health supply factors, population characteristics and political party alignments.
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Affiliation(s)
- Ece A Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
- Department of Administration, São Paulo School of Business Administration, Fundação Getulio Vargas, Avenue Nove de Julho, 2029, São Paulo 01313-902, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Russo LX. Effect of More Doctors (Mais Médicos) Program on geographic distribution of primary care physicians. CIENCIA & SAUDE COLETIVA 2021; 26:1585-1594. [PMID: 33886785 DOI: 10.1590/1413-81232021264.26932020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
This study assesses the effect of More Doctors Program (Programa Mais Médicos - PMM) on the equality in the distribution of primary care physicians (PCPs) in Brazil. Spatial data analysis, Lorenz curve and Gini coefficient were used to evaluate the geographic distribution of PCPs before and after the implementation of PMM (2012 and 2016). Data from 5,564 municipalities were used in the analyses. The results indicate that the distribution of PCPs has become more equal after PMM implementation. Between 2012 and 2016, overall Gini coefficient decreased by 11% from 0.255 to 0.227. At the state level, a statistically significant trend towards a more equal distribution of PCPs was found in 21 out of 26 Brazilian states. However, there still remains a substantial difference in the level of equality in PCP distribution, especially across states, with Gini coefficient ranging from 0.093 to 0.341 in 2016.
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Affiliation(s)
- Letícia Xander Russo
- Faculdade de Administração, Ciências Contábeis e Economia, Universidade Federal da Grande Dourados. Km 12, Caixa postal 364, Rod. Dourados-Itahum. 79804-970 Dourados MS Brasil.
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Cavalcante DDFB, Domingues CV, Meloni DR, Almeida FMD, Probst LF, Cavalcanti YW, Meneghim MDC, Pereira AC. Financial impact of the change in the vulnerability profile of More Doctors Program. Rev Saude Publica 2020; 54:148. [PMID: 33331491 PMCID: PMC7726938 DOI: 10.11606/s1518-8787.2020054002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To estimate the flow of professionals and the financial impact of the Programa Mais Médicos para o Brasil (PMMB - More Doctors for Brazil Program) within the More Doctors Program (MDP) for the Brazilian Ministry of Health and the participating municipalities of the state of São Paulo, from January 2019 to March 2022. METHODS A financial impact study was conducted in the state of São Paulo based on public secondary databases. The number of PMMB vacancies per municipality, of physicians and vulnerability profiles were described to measure the loss of replacement of professionals in the period. RESULTS In the specified period, the number of PMMB physicians in participating cities will decrease from 2,533 to 320, and the number of participating municipalities from 373 to 86. The municipalities that will need to replace the physicians will have a financial impact of R$ 929,487,904.77 (with sensitivity analysis, ranging from R$ 650,641,533.34 to R$ 1,208,334,276.20). CONCLUSION The change of vulnerability methodology adopted for the PMMB will represent serious consequences, that is, less population assistance and high financial impact for the municipalities of the state of São Paulo in a scenario of budget limitations.
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Affiliation(s)
- Denise de Fátima Barros Cavalcante
- Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Pós-Doutoranda em Odontologia em Saúde Coletiva. Piracicaba, SP, Brasil
| | - Carolina Vitti Domingues
- Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Programa de Pós-Graduação em Odontologia. Piracicaba, SP, Brasil
| | - Diego Roberto Meloni
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde Pública. Ribeirão Preto, SP, Brasil
| | | | - Livia Fernandes Probst
- Universidade Federal de Mato Grosso do Sul. Faculdade de Odontologia de Campo Grande. Departamento de Saúde Coletiva. Campo Grande, MS, Brasil
| | - Yuri Wanderley Cavalcanti
- Universidade Federal da Paraíba. Centro de Ciências da Saúde. Departamento de Odontologia Social. Joao Pessoa, PB, Brasil
| | - Marcelo de Castro Meneghim
- Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Social. Piracicaba, SP, Brasil
| | - Antonio Carlos Pereira
- Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Social. Piracicaba, SP, Brasil
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Özçelik EA, Massuda A, McConnell M, Castro MC. Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions. SSM Popul Health 2020; 12:100695. [PMID: 33319027 PMCID: PMC7725939 DOI: 10.1016/j.ssmph.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of -1.47 (95%CI: -4.04,1.10) for hospitalizations for cerebrovascular disease and -1.20 (95%CI: -5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was -0.50 (95%CI: -2.94,1.95) in the year of program introduction, -5.21 (95%CI: -9.43,-0.99) and -8.21 (95%CI: -13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.
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Affiliation(s)
- Ece A. Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Hone T, Powell-Jackson T, Santos LMP, de Sousa Soares R, de Oliveira FP, Sanchez MN, Harris M, de Oliveira de Souza Santos F, Millett C. Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities. BMC Health Serv Res 2020; 20:873. [PMID: 32933503 PMCID: PMC7491024 DOI: 10.1186/s12913-020-05716-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. METHODS Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008-2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. RESULTS After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of - 1.06 per 100,000 (95%CI: - 1.78 to - 0.34) annually - with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. CONCLUSIONS PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | | | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, London, UK
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O’Dwyer G, Graever L, Britto FA, Menezes T, Konder MT. A crise financeira e a saúde: o caso do município do Rio de Janeiro, Brasil. CIENCIA & SAUDE COLETIVA 2019; 24:4555-4568. [DOI: 10.1590/1413-812320182412.23212019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/12/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo explorou os efeitos da crise financeira nas receitas e despesas, na produção de serviços e indicadores de saúde e de desempenho no município do Rio de Janeiro no período de 2013 a 2018. Analisou-se receitas, despesas, parâmetros de provisão de serviços e indicadores de desempenho e de saúde, a partir de dados de acesso livre e restrito. Utilizou-se a análise institucional de Giddens. As receitas e despesas sofreram redução, sendo maiores nos investimentos e receitas não vinculadas. A provisão de serviços encolheu, com queda da cobertura na Atenção Primária, produção ambulatorial, internações totais, número de leitos, médicos e agentes comunitários de saúde, cirurgias realizadas e taxa de ocupação de hospitais. Os tempos de espera para ambulâncias, exames e consultas ambulatoriais, bem como o número de solicitações pendentes na regulação aumentaram. Indicadores de saúde e desempenho persistiram, em sua maioria, dentro dos parâmetros anteriores, corroborando a potência assistencial da Atenção Primária, apesar do impacto financeiro e estrutural da austeridade. A conjuntura atual ameaça o direito à saúde e as respostas governamentais, como a desvinculação de receitas, sinalizam uma ampliação desse risco.
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Maffioli EM, Hernandes Rocha TA, Vivas G, Rosales C, Staton C, Nickenig Vissoci JR. Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil. BMJ Glob Health 2019; 4:e001827. [PMID: 31798991 PMCID: PMC6861089 DOI: 10.1136/bmjgh-2019-001827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brazil faces huge health inequality challenges since not all municipalities have access to primary care physicians. The More Doctors Programme (MDP), which started in 2013, was born out of this recognition, providing more than 18 000 doctors in the first few years. However, the programme faced a restructuring at the end of 2018. METHODS We construct a panel municipality-level data between 2008 and 2017 for 5570 municipalities in Brazil. We employ a difference-in-differences empirical approach, combined with propensity score matching, to study the impacts of the programme on hospitalisations for ambulatory care sensitive conditions and its costs. We explore heterogeneous impacts by age of the patients, type of admissions, and municipalities that were given priority. FINDINGS The MDP reduced ambulatory admissions by 2.9 per cent (p value <0.10) and the costs by 3.7 per cent (p value <0.01) over the mean. The reduction was driven by infectious gastroenteritis, bacterial pneumonias, asthma, kidney and urinary infections, and pelvic inflammatory disease. The results held on the subsample of municipalities targeted by the programme. By comparing the benefits of the programme from the reduction in the costs of ambulatory admissions to the total financial costs of the MDP, the impacts allowed the government to save at least BRL 27.88 (US$ 6.9 million) between 2014 and 2017. CONCLUSION Addressing inequalities in the distribution of the medical workforce remains a global challenge. Our results inform the discussion on the current strategy adopted in Brazil to increase access to primary healthcare in underserved areas.
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Affiliation(s)
| | | | - Gabriel Vivas
- Pan American Health Organization Brazil, Nassau, Bahamas
| | - Carlos Rosales
- Pan American Health Organization Brazil, Brasilia, Brazil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Russo LX, Scott A, Sivey P, Dias J. Primary care physicians and infant mortality: Evidence from Brazil. PLoS One 2019; 14:e0217614. [PMID: 31150468 PMCID: PMC6544253 DOI: 10.1371/journal.pone.0217614] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/15/2019] [Indexed: 11/25/2022] Open
Abstract
Primary health care has been recognized as a critical strategy for improving population health in developing countries. This paper investigates the effect of primary care physicians on the infant mortality rate in Brazil using a dynamic panel data approach. This method accounts for the endogeneity problem and the persistence of infant mortality over time. The empirical analysis uses an eight-year panel of municipalities between 2005 and 2012. The results indicate that primary care physician supply contributed to the decline of infant mortality in Brazil. An increase of one primary care physician per 10,000 population was associated with 7.08 fewer infant deaths per 10,000 live births. This suggests that, in addition to other determinants, primary care physicians can play an important role in accounting for the reduction of infant mortality rates.
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Affiliation(s)
| | - Anthony Scott
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Sivey
- School of Economics Finance and Marketing, RMIT University, Melbourne, Victoria, Australia
| | - Joilson Dias
- Department of Economics, State University of Maringá, Maringá Paraná, Brazil
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Contribuição para uma agenda política estratégica para a Atenção Primária à Saúde no SUS. SAÚDE EM DEBATE 2018. [DOI: 10.1590/0103-11042018s128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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