Pagamento por desempenho às Equipes da Atenção Básica: análise a partir dos ciclos do PMAQ-AB

Rodrigues, André Wagner; Mello, Emmanuella Costa de Azevedo; Candeia, Rozileide Martins Simões; Silva, Geane; Gomes, Luciano Bezerra; Sampaio, Juliana

doi:10.1590/0103-1104202113109

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…Our study contributes to two previous studies of PMAQ design at the municipal level. The variation in scheme design was consistent with that identified through a survey conducted in Paraiba state ( Rodrigues et al ., 2021 ) across some domains: with 65.3% allocating 40–60% of the PMAQ resources to teams in Paraiba (compared to 58.7% in our study). There was also a broader perception of the team incentivized, including NASF and staff in both studies.…”

Section: Discussionsupporting

confidence: 80%

“…Despite growing research on PMAQ, evidence on the programme design at the municipal level and its effects is scarce, a knowledge gap that was recently emphasized in a systematic review ( Resende et al ., 2021 ). The existing literature has tended to focus on a single region in Brazil ( Rodrigues et al ., 2021 ), with the exception of one national study that assessed the effect of sharing bonuses with FHT on quality of care using national programme data ( Fardousi et al ., 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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Does pay-for-performance design matter? Evidence from Brazil

Russo,

Powell-Jackson,

Borghi

et al. 2024

Health Policy and Planning

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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 (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 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 family health team 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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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Does pay-for-performance design matter? Evidence from Brazil

Russo,

Powell-Jackson,

Borghi

et al. 2024

Health Policy and Planning

Self Cite

View full text Add to dashboard Cite

show abstract

“…These aspects were probably mentioned due to the influence of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ), implemented in 2011 by the Brazilian Ministry of Health, aimed to induce the expansion of PHC access and quality. There was, therefore, a context of encouraging quality improvement, in which the teams joined the program voluntarily, and the financial incentive was passed on to the municipalities according to the performance achieved ( 25 , 26 ).…”

Section: Discussionmentioning

confidence: 99%

Interventions of Brazil's more doctors program through continuing education for Primary Health Care

Pereira,

Silva,

Valentim

et al. 2024

Front. Public Health

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IntroductionBrazil's More Doctors Program, in its training axis, aims to improve medical training for Primary Health Care through interventions related to the reality of the territory. The research presented here analyzed the interventions implemented by Brazil's More Doctors Program physicians, members of the Family Health Continuing Education Program, and the relationship with Primary Health Care programmatic actions.MethodologyThe research conducted made use of Text and Data Mining and content analysis. In total, 2,159 reports of interventions from 942 final papers were analyzed. The analysis process was composed of the formation of the corpus; exploration of the materials through text mining; and analysis of the results by inference and interpretation.ResultsIt was observed that 57% of the physicians worked in the Northeast Region, which was also the region with the most interventions (66.8%). From the analysis of the bigrams, trigrams, and quadrigrams, four constructs were formed: “women's health,” “child health,” “chronic non-communicable diseases,” and “mental health.” Terms related to improving access, quality of care, teamwork, and reception were also present among the N-grams.DiscussionThe interventions carried out are under the programmatic actions recommended by the Brazilian Ministry of Health for Primary Health Care, also addressing cross-cutting aspects such as Reception, Teamwork, Access Improvement, and Quality of Care, which suggests that the training experience in the Family Health Continuing Education Program reflects on the way these professionals act.

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“…Já no Governo Bolsonaro, em 2019, uma das primeiras ações foi a criação do Programa Previne Brasil, com mudanças no financiamento e sistemas de avaliação da AB, extinguindo o Programa de Melhoria do Acesso e Qualidade da Atenção Básica e do CEO (PMAQ-AB e PMAQ-CEO). Os efeitos da extinção do PMAQ necessitam ser melhor compreendidos, mas há estudos que ressaltam os resultados alcançados pelo programa, criado em 2011, e alertam para os prejuízos de sua descontinuidade 28,29 .…”

Section: As Transformações Da Pnsb Nos Governos Temer E Bolsonarounclassified

Política de Saúde Bucal no Brasil: transformações e rupturas entre 2018-2021

Santos

Lima

Chaves

et al. 2023

Ciênc. saúde coletiva

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Resumo Analisou-se a implementação da Política de Saúde Bucal no Brasil no período 2018-2021, através das ações institucionais, implantação dos serviços, resultados alcançados e financiamento federal. Estudo de monitoramento, a partir da análise documental e de dados secundários, obtidos em sites institucionais, sistemas de informações governamentais e notícias publicadas por entidades odontológicas. Todos os indicadores de resultados monitorados apresentaram expressiva redução dos valores entre 2020-2021, com agravamento desde 2018, como a cobertura da primeira consulta odontológica e ação coletiva de escovação dental supervisionada, que chegou a 1,8% e 0,02% em 2021, respectivamente. Observa-se uma queda do financiamento federal nos anos 2018-2019 (8,45%), com crescimento em 2020 (59,53%) e nova diminuição em 2021 (5,18%). O período analisado foi marcado por crise econômica e política, agravadas pela crise sanitária, decorrente da pandemia do COVID-19. Contexto que influenciou o funcionamento dos serviços de saúde no Brasil. No caso particular da saúde bucal, verificou-se progressiva e acentuada redução dos resultados, ainda que a implantação dos serviços de atenção básica e especializada tenha se mantido estável.

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Pagamento por desempenho às Equipes da Atenção Básica: análise a partir dos ciclos do PMAQ-AB

Cited by 7 publications

References 15 publications

Does pay-for-performance design matter? Evidence from Brazil

Does pay-for-performance design matter? Evidence from Brazil

Interventions of Brazil's more doctors program through continuing education for Primary Health Care

Política de Saúde Bucal no Brasil: transformações e rupturas entre 2018-2021

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