Author | Russo, Letícia Xander | |
Author | Powell-Jackson, Timothy | |
Author | Barreto, Jorge Otavio Maia | |
Author | Borghi, Josephine | |
Author | Kovacs, Roxanne | |
Author | Gurgel Junior, Garibaldi Dantas | |
Author | Gomes, Luciano Bezerra | |
Author | Sampaio, Juliana | |
Author | Shimizu, Helena Eri | |
Author | Sousa, Allan Nuno Alves de | |
Author | Bezerra, Adriana Falangola Benjamin | |
Author | Stein, Airton Tetelbom | |
Author | Silva, Everton Nunes da | |
Access date | 2022-08-05T14:00:58Z | |
Available date | 2022-08-05T14:00:58Z | |
Document date | 2021 | |
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. | pt_BR |
ISSN | 2059-7908 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/54472 | |
Sponsorship | This research was funded by the Medical Research Council, Newton
Fund and the Brazilian National Council for the States Funding Agencies (CONFAP)
under the UK- Brazil Joint Health Systems Research Call (grant MR/R022828/1).
Funding from CONFAP came from Fundação de Amparo à Pesquisa do Distrito
Federal (FAPDF), Fundação de Amparo à Ciência e Tecnologia do Estado de
Pernambuco (FACEPE) and Fundação de Apoio à Pesquisa do Estado da Paraíba
(FAPESQ). | pt_BR |
Language | eng | pt_BR |
Publisher | Springer Nature | pt_BR |
Rights | open access | pt_BR |
MeSH | Health Care Economics and Organizations | pt_BR |
MeSH | Health Policy | pt_BR |
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 | pt_BR |
Type | Article | pt_BR |
DOI | 10.1136/bmjgh-2021-005429 | |
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 | pt_BR |
Affilliation | Federal University of Grande Dourados. Department of Economics. Dourados, MS, Brazil. | pt_BR |
Affilliation | London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil. | pt_BR |
Affilliation | London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom. | pt_BR |
Affilliation | London School of Hygiene and Tropical Medicine. Department of Global Health and Development. London, United Kingdom. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil | pt_BR |
Affilliation | Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil. | pt_BR |
Affilliation | Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil. | pt_BR |
Affilliation | University of Brasilia. Department of Collective Health. Brasília, DF, Brazil. | pt_BR |
Affilliation | Ministry of Health. Brasilia, DF, Brazil. | pt_BR |
Affilliation | Federal University of Pernambuco. Department of Social Medicine. Recife, PE, Brazil. | pt_BR |
Affilliation | Federal University of Health Sciences of Porto Alegre. Department of Public Health. Porto Alegre, RS, Brazil. | pt_BR |
Affilliation | University of Brasilia. Faculty of Ceilandia. Brasilia, DF, Brazil. | pt_BR |
Subject | Health economics | pt_BR |
Subject | Health policy | pt_BR |
Subject | Public health | pt_BR |
DeCS | Economia e Organizações de Saúde | pt_BR |
DeCS | Políticas Públicas | pt_BR |
DeCS | Política de Saúde | pt_BR |
DeCS | Saúde Pública | pt_BR |