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Russo LX, Powell-Jackson T, Borghi J, Sampaio J, Gurgel Junior GD, Shimizu HE, Bezerra AFB, E Silva KSDB, Barreto JOM, de Carvalho ALB, Kovacs RJ, Gomes LB, Fardousi N, da Silva EN. Does pay-for-performance design matter? Evidence from Brazil. Health Policy Plan 2024; 39:593-602. [PMID: 38661300 PMCID: PMC11145906 DOI: 10.1093/heapol/czae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/14/2024] [Accepted: 04/23/2024] [Indexed: 04/26/2024] Open
Abstract
Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] and exploring the association of alternative design typologies with the performance of primary health care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team (FHT) performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to FHT workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20-80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the 'large bonus/many workers/high-frequency' cluster was 8.44 points higher than the 'no bonus' cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.
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Affiliation(s)
- Letícia Xander Russo
- Faculty of Business, Accounting and Economics, Federal University of Grande Dourados, Rodovia Dourados—Itahum, Km 12, Dourados, MS 79804-970, Brazil
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Juliana Sampaio
- Department of Health Promotion, Federal University of Paraiba, João Pessoa 58051-900, Brazil
| | | | - Helena Eri Shimizu
- Department of Collective Health, University of Brasilia, Brasilia 70910-900, Brazil
| | | | - Keila Silene de Brito E Silva
- Collective Health Nucleous, Academic Center of Vitória, Federal University of Pernambuco, Vitória de Santo Antão 55608-680, Brazil
| | | | | | - Roxanne J Kovacs
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Luciano Bezerra Gomes
- Department of Health Promotion, Federal University of Paraiba, João Pessoa 58051-900, Brazil
| | - Nasser Fardousi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom
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Liu Z, Wang Z, Xu M, Ma J, Sun Y, Huang Y. The priority areas and possible pathways for health cooperation in BRICS countries. Glob Health Res Policy 2023; 8:36. [PMID: 37641146 PMCID: PMC10464194 DOI: 10.1186/s41256-023-00318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
As one of the largest alliances of middle-income countries, the BRICS, known as an acronym for five countries including "Brazil, Russia, India, China, and South Africa", represents half of the global population. The health cooperation among BRICS countries will benefit their populations and other middle- and low-income countries. This study aims to summarize the current status of health cooperation in BRICS countries and identify opportunities to strengthen BRICS participation in global health governance. A literature review was conducted to analyze the status, progress, and challenges of BRICS' health cooperation. Content analysis was used to review the 2011-2021 annual joint declarations of the BRICS Health Ministers Meetings. The priority health areas were identified through segmental frequency analysis. Our research suggested that communicable diseases, access to medicine, and universal health coverage appeared most frequently in the content of declarations, indicating the possible top health priorities among BRICS' health collaboration. These priority areas align with the primary health challenges of each country, including the threats of double burden of diseases, as well as the need for improving health systems and access to medicines. Respective external cooperation, inter-BRICS health cooperation, and unified external cooperation are the main forms of health cooperation among BRICS countries. However, challenges such as the lack of a unified image and precise position, lack of practical impact, and weak discourse power have impeded the impact of BRICS on health governance. This study suggests that the BRICS countries should recognize their positioning, improve their unified image, and establish cooperative entities; at the same time, they should increase their practical strength, promote non-governmental cooperation, and expand the cooperation space through the "BRICS Plus" mechanism with countries with similar interests to join.
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Affiliation(s)
- Zuokun Liu
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zongbin Wang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Ming Xu
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Jiyan Ma
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yinuo Sun
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yangmu Huang
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Ferreira GRON, Miranda ALC, Farias VA, Martins MB, Neri DT, Borges WD, Cunha CLF, Dias GAR, Santos DC, Sousa FJD. Leprosy and tuberculosis control scenario of the national program for the improvement of access and quality of primary care in Brazil. BMC Health Serv Res 2023; 23:825. [PMID: 37533030 PMCID: PMC10394934 DOI: 10.1186/s12913-023-09842-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND In Brazil, despite advances in public health policies aimed at eliminating and controlling infectious and parasitic diseases, the incidence of neglected diseases is still high. The epidemiological scenario in Brazil of diseases such as tuberculosis and leprosy evidences a public policy agenda that has not been resolute in terms of control, nor in terms of elimination. OBJECTIVE To analyze the actions of diagnosis and treatment of leprosy and tuberculosis in the context of primary health care. METHODS In this ecological study, data from the third cycle of the Program for the Improvement of Access and Quality of Primary Care were extracted from electronic address of the Primary Health Care Secretariat of Brazil in the area of Actions, Programs and Strategies. A total of 37,350 primary health care teams were that answered the questionnaire were eligible, with variables extracted from leprosy and tuberculosis control actions. The municipalities were grouped according to the characteristic of the Brazilian municipality. The partition chi-square and the Residuals Test were used to assess whether there was a difference in the proportion of tuberculosis and leprosy actions between types of municipalities. Statistics were carried out using Minitab 20 and Bioestat 5.3. RESULTS Regarding the leprosy treatment location, there is a higher proportion of people referred to be treated at the reference in adjacent rural (p = 0.0097) and urban (p < 0.0001) municipalities; monitoring of people with leprosy referred to the service network (p. = 0.0057) in remote rural areas. Lower proportion of teams requesting bacilloscopy in remote rural areas (p = 0.0019). Rural areas have a higher proportion of teams that diagnose new cases (p = 0.0004). Regarding the actions of diagnosis and treatment of tuberculosis. There is a higher proportion of teams that carry out consultations at the unit itself in rural areas when compared to adjacent intermediaries (p = 0.0099) and urban (p < 0.0001); who requested sputum smear microscopy in adjacent intermediaries (p = 0.0021); X-ray in adjacent intermediaries (p < 0.0001) and urban (p < 0.0001); collection of the first sputum sample in urban (p < 0.0001) and adjacent rural areas (p < 0.0001); directly observed treatment (p < 0.0001) in adjacent rural municipalities. CONCLUSION There are inequalities in the diagnosis and treatment of leprosy and tuberculosis among the types of municipalities.
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Affiliation(s)
- Glenda R O N Ferreira
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil.
| | - Amanda L C Miranda
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - Viviane A Farias
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - Melissa B Martins
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - Débora Talitha Neri
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - William D Borges
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - Carlos Leonardo F Cunha
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | - Geyse Aline R Dias
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
| | | | - Fabianne J D Sousa
- Programa de Pós Graduação em Enfermagem, Federal University of Para, Rua Augusto Correa, 01 - Setor Saúde. Guamá, Belém, Pará, 66075-110, Brazil
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Santos KBM, dos Reis RCP, Duncan BB, D’Avila OP, Schmidt MI. Access to diabetes diagnosis in Brazil based on recent testing and consultation: The Brazilian national health survey, 2013 and 2019. Front Endocrinol (Lausanne) 2023; 14:1122164. [PMID: 37033271 PMCID: PMC10073740 DOI: 10.3389/fendo.2023.1122164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Screening for undiagnosed diabetes using glucose testing is recommended globally to allow preventive action among those detected. Our aim was to evaluate the access to glucose testing to screen for diabetes in Brazil using self-reported information on recent testing and medical consultation from national surveys of Brazilian adults. METHODS The Pesquisa Nacional de Saúde (PNS) was conducted in 2013 and 2019 drawing probabilistic samples of Brazilians aged 18 years and above. To evaluate glucose testing among those undiagnosed, we excluded those self-reporting a previous diagnosis of diabetes. We then defined recent access to diabetes diagnosis by considering the previous two years and choosing the last blood glucose test and the proximal medical consultation reported. We used Poisson regression with robust variance to assess correlates of access, expressing them with adjusted prevalence ratios (PR) and their 95% confidence intervals. RESULTS Access to recent glucose testing documented that over 70% reported a recent glycemic test, 71% in 2013, and 77% in 2019. These findings are consistent with a wide recent access to medical consultation, 86% and 89% in 2013 and 2019, respectively. Reporting recent glucose testing and medical consultation may better reflect the actual access to medical diagnostic testing. When analyzing this joint outcome, diagnostic access was still wide, 67% and 74%, respectively. Greater access (p< 0.001) was seen for women (PR=1.16; 1.15-1.17), older individuals (PR=1.25; 1.22-1.28), and those with higher education (PR=1.17; 1.15-1.18), obesity (PR=1.06; 1.05-1.08), and hypertension (PR=1.12; 1.11-1.13). In contrast, lower access (p<0.001) was seen for those declaring being Black (PR=0.97; 0.95-0.99) or of mixed-race (PR=0.97; 0.96-0.98), those residing in rural areas (PR=0.89; 0.87-0.90), and not having a private health insurance plan (PR=0.85; 0.84-0.86). CONCLUSIONS Although access to diagnostic testing for diabetes is high in Brazil, partly due to its universal health system, social inequities are still present, demanding specific actions, particularly in rural areas and among those self-declaring as being Black or mixed-race.
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Affiliation(s)
- Karine Brito Matos Santos
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Brazil
| | - Rodrigo Citton P. dos Reis
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Statistics Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- *Correspondence: Rodrigo Citton P. dos Reis,
| | - Bruce B. Duncan
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Maria Inês Schmidt
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Social Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Seabra I, Ferreira GRON, Sorensen W, Oliveira C, Parente AT, Gir E, Reis RKK, Ferrari RAP, Botelho E. Spatial scenery of congenital syphilis in Brazil between 2007 and 2018: an ecological study. BMJ Open 2022; 12:e058270. [PMID: 35443962 PMCID: PMC9021778 DOI: 10.1136/bmjopen-2021-058270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To analysis the epidemiological scenery of the congenital syphilis (CS) in Brazil employing spatial analysis techniques. DESIGN Ecological study. SETTINGS This study was conducted in Brazil SAMPLE: A total of 151 601 CS cases notified to the Diseases and Notification Information System from 2007 to 2018 from children aged 0-23 months and born from mothers living in Brazil were included in this study. PRIMARY OUTCOME MEASURES The CS incidence rates were calculated by triad (2007-2010, 2011-2014 and 2015-2018) for all Brazilian municipalities following the Boxcox transformation to remove the discrepant values. The transformed rates were analysed through the spatial autocorrelation of Moran, Kernel density estimative and spatial scan. RESULTS From 2007 to 2018, the CS incidence rates increased in all Brazilian regions. The CS spread towards the interior of Brazil, and a higher expansion was noticed between 2015 and 2018. The municipalities that were greatly affected by the CS were those having a high migration of people, such as the ones bordering other countries and the touristic cities. Recife, Campo Grande, Rio de Janeiro, Porto Alegre and Manaus were the capitals with the greatest spatial and spatiotemporal risk. CONCLUSION This study provides assistance to health authorities to fight CS in Brazil. More investment is necessary in prenatal care quality focusing on pregnant women and their partners to guarantee their full access to preventive resources against sexually transmitted infections.
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Affiliation(s)
- Iaron Seabra
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - William Sorensen
- Health & Kinesiology Department, University of Texas at Tyler, Tyler, Texas, USA
| | - Carmem Oliveira
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
| | | | - Elucir Gir
- College of Nursing, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | | | - Eliã Botelho
- Nursing Graduate Program, Federal University of Para, Belém, Pará, Brazil
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Harzheim E, D’Avila OP, Pedebos LA, Wollmann L, Costa LGM, Cunha CRHD, Moura LND, Minei T, Faller LDA. Atenção primária à saúde para o século XXI: primeiros resultados do novo modelo de financiamento. CIENCIA & SAUDE COLETIVA 2022; 27:609-617. [DOI: 10.1590/1413-81232022272.20172021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 11/21/2022] Open
Abstract
Resumo O Brasil, desde 1994, oferta serviços de atenção primária à saúde (APS) a partir da Estratégia Saúde da Família (ESF). A ESF alcançou resultados importantes. Nesse período, o modelo de financiamento da APS não sofreu alterações metodológicas importantes. Neste artigo, descreve-se os resultados do novo modelo de financiamento para APS aprovado de forma tripartite em 2019, o “Previne Brasil”, que é composto por (i) capitação ponderada, (ii) incentivos a ações específicas e estratégicas e (iii) pagamento por desempenho. Esses primeiros resultados revelam o incremento de mais de 50 milhões de pessoas com cadastro qualificado e único, associado ao número recorde de mais de 52 mil equipes de Saúde da Família/Equipe de Atenção Primária (EAP) financiadas pelo Ministério da Saúde, sendo mais de 35 mil (67%) com uso de prontuário eletrônico. Além disso, o cadastro das pessoas e dos profissionais da APS brasileira junto ao Sistema de Informação em Atenção Básica (SISAB) se configura como o maior conjunto de dados demográficos e clínicos de saúde do mundo. Esses avanços favorecem a superação das dificuldades para o alcance de maior acesso, longitudinalidade e coordenação do cuidado, qualificando a APS brasileira em busca de melhores resultados em saúde.
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Thomaz EBAF, Costa EM, Queiroz RCDS, Emmi DT, Ribeiro AGA, Silva NCD, Hugo FN, Figueiredo N. Advances and weaknesses of the work process of the oral cancer care network in Brazil: A latent class transition analysis. Community Dent Oral Epidemiol 2021; 50:38-47. [PMID: 34967970 DOI: 10.1111/cdoe.12711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/07/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the provision of oral cancer (OC) care services in the Dental Specialties Centers (Centros de Especialidades Odontológicas-CEO) in Brazil and identify changes over two cycles of external evaluation of the Program for the Improvement of Access and Quality-PMAQ, in 2014 and 2018. METHOD This is a nationwide panel ecological study, including 916 CEO. Data from interviews with managers and dentists of the CEO were used, including variables related to training on OC, clinical protocols, biopsies, referral for diagnosis and treatment, and registration of users with OC. We carried out Latent Transition Analysis (LTA) to identify patterns (latent status LS) of service adequacy and work processes' changes between the two assessment cycles. We tested models with three, four, and five LS, selecting the one with the best conceptual interpretability and good model fit parameters. Data from the LS were plotted on choropleth and hotspots maps in Brazil allowing us to identify areas with the better or worse provision of specialized OC services. RESULTS The model with four LS was chosen. The four LS were named: 1.'Most indicators inadequate for OC care' (the worst); 2. 'Most indicators suitable for OC care' (the best); 3. 'CEO with a poor relation with Primary Health Care (PHC) services'; and 4. 'CEO with a poor relation with tertiary hospital services'. The comparison of the LS transition between the two cycles revealed that 419 (45.7%) CEO remained in the same LS (1→1, 3→4, 2→2); 228 (24.9%) switched to a worse status (2→1, 2→4, 3→1) and 269 (29.4%) switched to a better LS (1→2, 1→4, 3→2). While the majority of the CEO improved, we identified a decline of 17.8% in those who reported performing biopsies and 18.3% in the number of CEO that had hospitals for referring confirmed OC cases. Almost all Brazilian states had CEO that improved the work process. The Southeast and South regions had the highest percentage of CEO with the better work process in both cycles. Hotspots showed areas concentrating improvements in the work process in the Northeast region. However, some hotspots in the North revealed some CEO where the work process deteriorated or remained unsatisfactory. CONCLUSIONS There are regional inequities in the provision of OC care in CEO. Most services improved their work process or remained stable. However, the biopsies and the referral to hospital care for confirmed cases declined, indicating that CEO need to improve planning and care provision to reduce OC morbimortality.
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Affiliation(s)
| | | | | | | | | | - Núbia Cristina da Silva
- Methods Analytics and Technology for Health Consortium, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nilcema Figueiredo
- Academic Area of Social Medicine, Federal University of Pernambuco, Recife, Brazil
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Faleiros DR, Pereira BLS. Balances of federal transfers in SUS: what we have and what to expect from the COVID-19 increment. CIENCIA & SAUDE COLETIVA 2021; 26:5639-5651. [PMID: 34852096 DOI: 10.1590/1413-812320212611.13712021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
We analyzed the balances from the transfers from the Ministry of Health (MH) to subnational entities, to finance the Unified Health System (SUS), including for COVID-19. We verified the representativeness of these in relation to the transfers from the MH to public health actions and services, between 2019and 2020. We analyzed the MH ordinances that gave rise to the COVID-19 transfers, classifying them as: quantity; object; apportionment criterion; amount of installments; execution linked to MH strategies; value. More than 70.000 current accounts were accounted for, and some subnational entities had more than 100. In 2019, balances reached R$16.29 billion (annual increase of 10.2%), representing 19.9% of the total transferred. In 2020, they reached R$23.83 billion (an increase of 46.3%), representing 21.1% of all transfers, with a monthly trend of continued growth. More than 616 ordinances, with 28 different objectives, transferred R$32.30 billion to COVID-19. The resource, originally freely available, had R$11.88 billion (36.8%) linked to the strategies of the MH: R$1.36 billion (99.9%) linked to the Structuring Block, and R$10.52 billion (34.0%) linked to the Maintenance Block. There are several causes that give rise to the accumulation of balances, however the quality, quantity and complexity of the SUS normative framework strongly contribute to an execution of resources that is not very fast, effective, efficient and useful.
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Affiliation(s)
- Daniel Resende Faleiros
- Faculdade de Farmácia, Universidade de Federal de Minas Gerais. Av. Pres. Antônio Carlos 6627, São Luiz. 31270-901 Belo Horizonte MG Brasil.
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Pinto LF, Quesada LA, D'Avila OP, Hauser L, Gonçalves MR, Harzheim E. Primary Care Assessment Tool: regional differences based on the National Health Survey from Instituto Brasileiro de Geografia e Estatística. CIENCIA & SAUDE COLETIVA 2021; 26:3965-3979. [PMID: 34586252 DOI: 10.1590/1413-81232021269.10112021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
In 2019, unprecedentedly among the official statistical institutes worldwide, the IBGE included a particular module on evaluating primary health care in its central population-based population survey, the National Health Survey (PNS-2019). The survey considered the reduced version of the Primary Care Assessment Tool (PCAT), developed and disseminated by Starfield and Shi, to assess the existence and extent of the structure and process characteristics of PHC services. It is the most significant probabilistic sample using this instrument ever conducted in a single country in the world that interviewed users aged 18 or over (n=9,677). The results of the Brazilian overall PCAT scores (5.9 [5.8; 5.9]) point to significant regional and intraregional contrasts, with the South of the country standing out with the best evaluations of primary care services (overall score = 6.3 [6.2; 6.5]) and the North with the worse (overall score = 5,5 [5,3; 5,7]). There were also statistically significant and more favorable differences between residents of households registered by family health teams, among older adults, and those using health services the most (adults with reported morbidities).
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Affiliation(s)
- Luiz Felipe Pinto
- Departamento de Medicina em Atenção Primária à Saúde, Universidade Federal do Rio de Janeiro. Rua Laura de Araujo 36 2º andar parte, Cidade Nova, 21250-540. Rio de Janeiro RJ Brasil. .,Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre Rio Grande do Sul Brasil
| | - Leonardo Arêas Quesada
- Coordenação de Trabalho e Rendimento, Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro RJ Brasil
| | - Otavio Pereira D'Avila
- Faculdade de Odontologia, Universidade Federal de Pelotas. Pelotas Rio Grande do Sul Brasil
| | - Lisiane Hauser
- Consultoria Estatística, Ministério da Saúde. Brasília DF Brasil
| | - Marcelo Rodrigues Gonçalves
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre Rio Grande do Sul Brasil
| | - Erno Harzheim
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul. Porto Alegre Rio Grande do Sul Brasil
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D'Avila OP, Chisini LA, Costa FDS, Cademartori MG, Cleff LB, Castilhos EDD. Use of Health Services and Family Health Strategy Households Population Coverage in Brazil. CIENCIA & SAUDE COLETIVA 2021; 26:3955-3964. [PMID: 34586251 DOI: 10.1590/1413-81232021269.11782021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/21/2022] Open
Abstract
The objective of this study is to describe the profile of use of primary health care services, estimated by the PNS, of the population living in households registered and not registered with the Famly Health Strategy - FHS, in the years 2013 and 2019. Cross-sectional study carried out using microdata from national health surveys 2013 and 2019. The sample originated from a master sample, consisting of a set of units from selected areas in a register..The variables sex, age, skin color, income, education, self-perceived health, home registered with the FHS, medical care in the last year, type of service you seek when you are ill were selected. The dependent variables were use of health services and use of public health services. The dependent and independent variables were described with the respective confidence interval and adjusted logistic regression was performed for each outcome analyzed. In public health services, lower income, have chronic diseases (arterial hypertension or high cholesterol), be pregnant, and having a bad self-perception of health were associated with used more health services in both periods. Living in registered households was associated with more used health services (public or private). The family health strategy is an important strategy for expanding access equally.
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Affiliation(s)
- Otávio Pereira D'Avila
- Faculdade de Odontologia, Universidade Federal de Pelotas. Rua Gonçalves Chaves, Centro. 96015-560 Pelotas RS Brasil.
| | | | | | - Mariana Gonzales Cademartori
- Faculdade de Odontologia, Universidade Federal de Pelotas. Rua Gonçalves Chaves, Centro. 96015-560 Pelotas RS Brasil.
| | - Lucas Brum Cleff
- Faculdade de Odontologia, Universidade Federal de Pelotas. Rua Gonçalves Chaves, Centro. 96015-560 Pelotas RS Brasil.
| | - Eduardo Dickie de Castilhos
- Faculdade de Odontologia, Universidade Federal de Pelotas. Rua Gonçalves Chaves, Centro. 96015-560 Pelotas RS Brasil.
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Russo LX, Powell-Jackson T, Maia Barreto JO, Borghi J, Kovacs R, Gurgel Junior GD, Gomes LB, Sampaio J, Shimizu HE, de Sousa ANA, Bezerra AFB, Stein AT, Silva EN. Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018. BMJ Glob Health 2021; 6:bmjgh-2021-005429. [PMID: 34244203 PMCID: PMC8273460 DOI: 10.1136/bmjgh-2021-005429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/18/2021] [Indexed: 01/13/2023] Open
Abstract
Background Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities. Methods We conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs. Results The results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected. Conclusion We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
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Affiliation(s)
- Letícia Xander Russo
- Department of Economics, Federal University of Grande Dourados, Dourados, Brazil
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Roxanne Kovacs
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Juliana Sampaio
- Department of Health Promotion, Federal University of Paraiba, Joao Pessoa, Brazil
| | - Helena Eri Shimizu
- Department of Collective Health, University of Brasilia, Brasilia, Brazil
| | | | | | - Airton Tetelbom Stein
- Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Pinto LF, D'Avila OP, Hauser L, Harzheim E. Innovations in the national household random sampling in Brazilian National Health Survey: results from Starfield and Shi's adult primary care assessment tool (PCAT). Int J Equity Health 2021; 20:113. [PMID: 33933098 PMCID: PMC8088307 DOI: 10.1186/s12939-021-01455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Several middle and upper income countries carry out household surveys that seek to trace the profile of access and use of health services. Probably one of the most ambitious examples is Brazil, with its National Health Survey (PNS-2019). We evaluated PNS-2019, presenting in an unprecedented way, one of its innovations, which refer to Starfield and Shi’s adult Primary Care Assessment Tool (PCAT). Methods Based on a cross-sectional study, we evaluated Module H of the PNS-2019, which interviewed a probabilistic sample of about 10,000 adults in 2019 in all 27 Brazilian states. According to the PCAT methodology, an average score equal to or above 6.6 indicates a greater orientation and quality of the evaluated primary care services. Results Brazilian overall PCAT score [5, 9] reveals the need to improve primary health care services across the country. There were no statistically significant differences in the scores by sex (men and women, 5.9), and race (whites 5.9 [5.7; 6.0] and brown / black 5.9 [5.8; 6.0]). On the other hand, there was a difference in terms of age. The elderly evaluated the services in a more positive way (score = 6.1 [6.0; 6.2]), when compared to those aged 40–59 years (5.9 [5.7; 6.0]) and 18 to 39 years (5.6 [5.5; 5.8]). First results of PNS-2019 show that the population that most needs primary care services in SUS is the one with the best perception and the most positive evaluation of the actions and procedures offered in health facilities. Discussion During 2019, Brazil undertook important structural reforms in PHC based on a new financing model with the aim of inducing an improvement in efficiency and strengthening its attributes. It is essential that countries with universal health coverage (UHC) guarantee access to their population and, especially, the most vulnerable, seek better efficiency of these services and regularly assess PHC based on the population’s perception, through an independent methodology that monitor the quality of services and the strength of PHC, generating value for public resources applied to health services.
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Affiliation(s)
- Luiz Felipe Pinto
- Department of Medicine in Primary Health Care, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), 36 Laura de Araújo Street, Cidade Nova, Rio de Janeiro, RJ, 20551-031, Brazil. .,Post-Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), 2400 Ramiro Barcellos Street, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.
| | - Otavio Pereira D'Avila
- Federal University of Pelotas (UFPel), 457 Gonçalves Chaves Street, Centro, Pelotas, RS, 96015-560, Brazil
| | - Lisiane Hauser
- Post-Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), 2400 Ramiro Barcellos Street, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
| | - Erno Harzheim
- Post-Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul (UFRGS), 2400 Ramiro Barcellos Street, Santa Cecília, Porto Alegre, RS, 90035-003, Brazil
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D'Avila OP, Harzheim E, Hauser L, Pinto LF, Castilhos EDD, Hugo FN. Validation of the Brazilian version of Primary Care Assessment Tool (PCAT) for Oral Health - PCATool Brazil Oral Health for Professionals. CIENCIA & SAUDE COLETIVA 2020; 26:2097-2108. [PMID: 34231722 DOI: 10.1590/1413-81232021266.23432020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/27/2020] [Indexed: 11/21/2022] Open
Abstract
This study verified the internal consistency and reliability of an instrument to evaluate dental services in Primary Health Care (PHC). In order to verify the factor validity, a factor analysis with principal component extraction and varimax orthogonal rotation method was used. Factors with three or more items with factor loadings greater than 0,35 were selected. This instrument's reliability was verified using internal consistency (total item correlation >0,30 and Cronbach alpha = or >0,70)). 562 dentists participated in the study. In the factor analysis, ten factors were kept, which explain 40,95% of the total variation. Regarding the internal consistency, only 3 items presented insufficient correlation. Also on internal consistency, using Cronbach's alpha, the following values of the coefficients were identified: Access (0.55), Continuity (0,74), Care Coordination (0,55), Coordination - Information System (0.21), Comprehensiveness of Services Available (0,91), Comprehensiveness of Services Provided (0,79), Family Orientation (0.66), Community Orientation (0,87), Cultural Competence (0,81). For the success ratio of the scale, all results were higher than 88%, less the "Information Systems" component (21%).
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Affiliation(s)
- Otávio Pereira D'Avila
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. R. Gonçalves Chaves 457, Centro. 96015-560 Pelotas RS Brasil
| | - Erno Harzheim
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil
| | - Lisiane Hauser
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil
| | - Luiz Felipe Pinto
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre RS Brasil.,Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| | - Eduardo Dickie de Castilhos
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. R. Gonçalves Chaves 457, Centro. 96015-560 Pelotas RS Brasil
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Carnut L, Mendes Á, Leite MG. Metodologias para alocação equitativa de recursos financeiros em saúde: uma revisão integrativa. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Há diversas experiências no mundo que visam ao desenvolvimento de metodologias para alocação de recursos para a saúde, contudo, o que resta saber é até que ponto a equidade é operacionalizada nesses métodos. Por isso, este estudo objetivou analisar o que tem sido produzido nas literaturas nacional e internacional a respeito das metodologias de alocação equitativas de recursos em saúde e suas dimensões. Realizou-se uma revisão integrativa em três portais/bases de dados (Bireme, PubMed e Scopus) de artigos científicos, publicados em português, inglês e espanhol. Foram identificados nos artigos o(s) objetivo(s), o método do estudo utilizado pelos pesquisadores e a abordagem sobre a metodologia de alocação de recursos em saúde no que se refere à discussão/operacionalização da equidade. Ainda são poucos os estudos em que alocação equitativa é tema central. Há certa imprecisão sobre a delimitação entre ‘alocar’ e ‘financiar’. Em geral, as metodologias precisam admitir as implicações (bio)éticas relativas à equidade, devem se basear minimamente na dimensão per capita, em conjunto, compulsoriamente, com a orçamentação incremental, com as questões sociodemográficas, sociossanitárias e epidemiológicas e ter centralidade na ‘necessidade de saúde’, sendo necessário um constante aperfeiçoamento da metodologia ao longo do tempo para refinar a operacionalidade da equidade.
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Affiliation(s)
| | - Áquilas Mendes
- Universidade de São Paulo, Brasil; Pontifícia Universidade Católica de São Paulo, Brasil
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Pinto LF, Hartz ZMDA. Primary care experiences in 25 years of Journal Ciência & Saúde Coletiva: a review of the scientific literature. CIENCIA & SAUDE COLETIVA 2020; 25:4917-4932. [PMID: 33295510 DOI: 10.1590/1413-812320202512.24882020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022] Open
Abstract
The term "basic care" is restricted to a few countries like Brazil. Since the 1978 Alma-Ata Conference, "primary health care" (PHC) has been used to designate care at the first level. The paper summarizes the experiences of evaluation in primary health care, based on the review of the set of manuscripts published by Journal Ciência & Saúde Coletiva. A bibliographic search was made in the SciELO database in the 1996-2020 period. Several descriptors were selected in the spectrum of evaluation and basic care/primary care. The reviewed studies suggest the existence of two analytical periods over the 25 years of the Journal. The first, characterized by the 1996-2010 studies, had the studies of structure/process/results by Donabedian as its predominant theory. The second, from 2011-2020, was Billings' theories on Ambulatory Care Sensitive Conditions (ACSC) and Starfield's PHC attributes. The main dimensions presented in the studies refer to evaluations with a quantitative approach and are induced by the policies and public consultations of the Ministry of Health, and instruments referenced by it.
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Affiliation(s)
- Luiz Felipe Pinto
- Programa de Pós-Graduação em Atenção Primária à Saúde, Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Av. Presidente Vargas 2863, Cidade Nova. 20210-030 Rio de Janeiro RJ Brasil. .,Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. Lisboa Portugal
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Harzheim E. "Previne Brasil": bases of the Primary Health Care Reform. CIENCIA & SAUDE COLETIVA 2020; 25:1189-1196. [PMID: 32267421 DOI: 10.1590/1413-81232020254.01552020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Erno Harzheim
- Secretaria de Atenção Primária à Saúde (SAPS), Ministério da Saúde (MS). Esplanada dos Ministérios, Bloco G/Edifício Sede/7º andar, Zona Cívico Administrativa. 70058-900 Brasília DF Brasil.
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