Novo financiamento para uma nova Atenção Primária à Saúde no Brasil

Harzheim, Erno; D’Ávila, Otávio Pereira; Ribeiro, Daniela de Carvalho; Ramos, Larissa Gabrielle; Silva, Lariça Emiliano da; Santos, Caroline Martins José dos; Costa, Luis Gustavo Mello; Cunha, Carlo Roberto Hackmann da; Pedebôs, Lucas Alexandre

doi:10.1590/1413-81232020254.35062019

Cited by 28 publications

(15 citation statements)

References 13 publications

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“…Similar results were found for Bahian municipalities by Teles, Coelho, and Ferreira (2016). Harzheim et al (2020), in turn, suggest a transfer distribution system based on socioeconomic vulnerability and demographic indicators as well as payment for indicator performance, endorsing the critiques of the current criteria.…”

Section: The Problem Of Financing Health Servicesmentioning

confidence: 91%

Os desafios do financiamento do enfrentamento à COVID-19 no SUS dentro do pacto federativo

Fernandes

Pereira

2020

Rev. Adm. Pública

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Resumo O aprimoramento das regras de financiamento do Sistema Único de Saúde (SUS) em estados e municípios é um dos grandes desafios da saúde pública no Brasil. O objetivo deste artigo é contribuir para este amplo debate, analisando a resposta governamental ao desafio de combate à COVID-19, sob o prisma do financiamento público dos serviços de saúde dos governos subnacionais brasileiros. Uma abordagem quali-quantitativa é adotada, mesclando-se análise documental e análise de regressão. Resultados mostram que não houve mudança substantiva nos critérios de repasse, pouco sensíveis a fatores epidemiológicos. Ajustes nas normas de aplicação foram realizados para dar maior agilidade aos gastos. Tamanho populacional, produção de riquezas locais e número de leitos de internação parecem ser os principais fatores que definem a distribuição dos recursos. O desenho de financiamento do combate à COVID-19, assim como o volume de recursos parecem ser insuficientes frente à dimensão da crise.

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Section: The Problem Of Financing Health Servicesmentioning

confidence: 91%

Os desafios do financiamento do enfrentamento à COVID-19 no SUS dentro do pacto federativo

Fernandes

Pereira

2020

Rev. Adm. Pública

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“…Finally, PMAQ was discontinued by the Brazilian Ministry of Health in December 2019, establishing new bases for PHC funding. 47 Although P4P had remained, it was completely reformulated, replacing hundreds of indicators, external evaluation, and equity concerns by very few indicators (just seven), restricted to few health conditions. Several authors have criticised the new funding of PHC and its impact on access and quality of care.…”

Section: Implication For Policymentioning

confidence: 99%

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

et al. 2021

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BackgroundEvidence 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.MethodsWe 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.ResultsThe 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.ConclusionWe find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.

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“…They will also be weighed, considering the most vulnerable population -children and older adults. The details of the adjustment factors for onlendings of federal financing amounts are detailed in another text in the press that makes up this thematic number 30 .…”

Section: Expected Challengesmentioning

confidence: 99%