Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/54472
Title: 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
Authors: Russo, Letícia Xander
Powell-Jackson, Timothy
Barreto, Jorge Otavio Maia
Borghi, Josephine
Kovacs, Roxanne
Gurgel Junior, Garibaldi Dantas
Gomes, Luciano Bezerra
Sampaio, Juliana
Shimizu, Helena Eri
Sousa, Allan Nuno Alves de
Bezerra, Adriana Falangola Benjamin
Stein, Airton Tetelbom
Silva, Everton Nunes da
Affilliation: Federal University of Grande Dourados. Department of Economics. Dourados, MS, Brazil.
London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom.
Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.
London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom.
London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom.
Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil
Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil.
Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil.
University of Brasilia. Department of Collective Health. Brasília, DF, Brazil.
Ministry of Health. Brasilia, DF, Brazil.
Federal University of Pernambuco. Department of Social Medicine. Recife, PE, Brazil.
Federal University of Health Sciences of Porto Alegre. Department of Public Health. Porto Alegre, RS, Brazil.
University of Brasilia. Faculty of Ceilandia. Brasilia, DF, Brazil.
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
Keywords: Health economics
Health policy
Public health
DeCS: Economia e Organizações de Saúde
Políticas Públicas
Política de Saúde
Saúde Pública
Issue Date: 2021
Publisher: Springer Nature
Citation: RUSSO, Letícia Xander et al. 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 Global Health, [s. l.], v. 6, n. 7, p.1-9, 2021.
DOI: 10.1136/bmjgh-2021-005429
ISSN: 2059-7908
Copyright: open access
Appears in Collections:BSB - Artigos de Periódicos
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