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This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct association of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discussed heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension, and diabetes.. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasise the role of having sufficient health teams to attend to the population.

O peso dos brasileiros vem aumentando nos últimos anos. A Pesquisa de Orçamentos Familiares (POF) 2002-2003 levantou que o país tinha cerca de 38,6 milhões de pessoas com peso acima do recomendado, o equivalente a 40,6% de sua população adulta. Deste total, 10,5 milhões eram obesos. Na POF 2008-2009, o excesso de peso em homens adultos saltou para 50,1% e ultrapassou, em 2008-2009, o das mulheres, que foi para 48%. Pretende-se verificar, de forma preliminar, se há relação entre obesidade nos salários através de uma análise empírica de modelos de regressão multivariada e de probabilidade de emprego. Foram utilizados microdados da POF 2008-2009. Os resultados indicam diferentes efeitos do IMC sobre salários e emprego para homens e mulheres. O efeito do IMC tanto sobre o salário e como sobre a probabilidade de emprego assume uma relação significativa positiva para homens e um impacto negativo para as mulheres. Para homens, verificamos que estar em situação de obesidade está associado a um prêmio de probabilidade de emprego de 2,2 pontos percentuais enquanto para mulheres, a mesma condição está associada a uma penalidade na probabilidade de emprego de 4,3 pontos percentuais.

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Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.

This paper assesses whether Brazilian primary health care is worth it in the long‐run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16 years. Significant heterogeneities in cost‐benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.

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