Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

Macinko, James; Harris, Matthew; Rocha, Marcia

doi:10.1097/jac.0000000000000189

Cited by 81 publications

(64 citation statements)

References 24 publications

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“…Some schemes rewarded just a handful of indicators, for instance a P4P scheme in Haut-Katang in the DRC rewarded seven indicators [45] or a P4P scheme in Haiti rewarded 14 indicators [46]. However, others are extremely complex, a good example is Brazil's national P4P scheme (called PMAQ -National Program for Improving Primary Care Access and Quality), which rewarded over 600 different indicators [47]. Often studies only reported a sub-set of incentivised indicators (for instance, those that are being measured or assessed within the study) and do not make it clear which other indicators are incentivised by the programme.…”

Section: Design Of P4p Schemes In Lmicsmentioning

confidence: 99%

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How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Kovacs

Powell‐Jackson

Kristensen

et al. 2020

BMC Health Serv Res

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Background: Pay for performance (P4P) schemes provide financial incentives to health workers or facilities based on the achievement of pre-specified performance targets and have been widely implemented in health systems across low and middle-income countries (LMICs). The growing evidence base on P4P highlights that (i) there is substantial variation in the effect of P4P schemes on outcomes and (ii) there appears to be heterogeneity in incentive design. Even though scheme design is likely a key determinant of scheme effectiveness, we currently lack systematic evidence on how P4P schemes are designed in LMICs. Methods: We develop a typology to classify the design of P4P schemes in LMICs, which highlights different design features that are a priori likely to affect the behaviour of incentivised actors. We then use results from a systematic literature review to classify and describe the design of P4P schemes that have been evaluated in LMICs. To capture academic publications, Medline, Embase, and EconLit databases were searched. To include relevant grey literature, Google Scholar, Emerald Insight, and websites of the World Bank, WHO, Cordaid, Norad, DfID, USAID and PEPFAR were searched. Results: We identify 41 different P4P schemes implemented in 29 LMICs. We find that there is substantial heterogeneity in the design of P4P schemes in LMICs and pinpoint precisely how scheme design varies across settings. Our results also highlight that incentive design is not adequately being reported on in the literaturewith many studies failing to report key design features. Conclusions: We encourage authors to make a greater effort to report information on P4P scheme design in the future and suggest using the typology laid out in this paper as a starting point.

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Section: Design Of P4p Schemes In Lmicsmentioning

confidence: 99%

“…It was not uncommon for schemes to measure the performance of one actor and provide payment to another actor. For instance, Brazil's national P4P scheme measured the performance of primary healthcare facilities but paid municipal health managers [47].…”

Section: Who Is Incentivised?mentioning

confidence: 99%

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Kovacs

Powell‐Jackson

Kristensen

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…According to Macinko et al 4 , PMAQ-AB can be considered as one of the largest global initiatives to improve the performance of Primary Care and it has led to double the federal investments in the area. According to the authors, the data generated are beginning to be used to understand the structural and operational constraints faced by health professionals.…”

Section: Introductionmentioning

confidence: 99%

Structural factors for public dental health services in Regional Health Care Network 13: an analysis of the Brazilian National Program for Improving Access and Quality of Primary Care

Hirooka

Catanante

Porto

et al. 2018

Rev. odontol. UNESP

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Introduction The Brazilian National Program for Improving Access and Quality of Primary Care aims to induce the institution of processes that expand the capacity of federal, state and municipal administrations and Primary Care teams to offer services that ensure greater access and quality. Objective To identify the characteristics of infrastructure for the dental health care of the health units from the Regional Health Care Network 13, from the perspective of a health evaluation. Material and method This is a descriptive and cross-sectional study in which is used the Module V database of the External Evaluation instrument of 156 health units of this region that participated of the 2nd cycle of the referred program, which discuss the modality of the health teams, structure and environment of the dental office, the hours of operation, equipment, instruments and dental supplies. Result In general, the oral health units of this study have dental offices with good structural conditions and sufficient equipment and supplies to carry out clinical activities, except those for dental prostheses, possibly due to the permanence of this service in secondary care. However, they point out that advances in access and coverage by oral health services are still necessary. Conclusion Although the theme includes other studies and reflections, the present work may contribute to discussions about the present condition, and it is recommended the active participation of all the actors involved in the care, in the search for the qualification of oral health services in this region.

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“…Unlike other countries engaging in P4P schemes, the Ministry of Health is not involved directly in these payments, instead municipal managers have the autonomy to choose whether to use P4P with participating teams from municipalities or simply to use the payments for primary care actions. Studies reveal that 39 000 Family Health Strategy teams participate in PMAQ and are located throughout the country (Macinko, Harris and Rocha, 2017 [4]).…”

Section: Application Of Pay-for-performance Schemesmentioning

confidence: 99%

“…Additional published research from Brazil shows that P4P has resulted in changes in the management regarding the work process of these teams. Since its debut, "PMAQ has led to an increase in federal investment for infrastructure and performance incentives in primary care from BRL 770 million in 2011/12 to BRL 4.2 billion (about USD 1.2 billion) in 2014/15" (Macinko, Harris and Rocha, 2017 [5]). These studies also argued that P4P has had an inductive role in increasing the quality and access of primary care services offered by teams participating in P4P programmes.…”

Section: Application Of Pay-for-performance Schemesmentioning

confidence: 99%

Budgeting practices to improve health system performance

James¹,

Beazley²,

Rosato³

et al. 2019

OECD Journal on Budgeting

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This article presents the main findings of two OECD Surveys of Senior Budget and HealthOfficials conducted in the Latin American and Caribbean region. The surveys help to understand the approaches to budgeting, and take account of the prominent role of agents in the health system across the region, including social health insurance agencies and subnational governments. The focus, however, is on the application of performance-orientated reforms to budgeting, and the extent to which countries in the region have adopted such reforms to improve the efficiency of health expenditure to achieve universal health coverage. The findings point to the use of performance and results-based budgeting in the region, along with new models of provider payment systems integrating performance measures.

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Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

Cited by 81 publications

References 24 publications

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review

Structural factors for public dental health services in Regional Health Care Network 13: an analysis of the Brazilian National Program for Improving Access and Quality of Primary Care

Budgeting practices to improve health system performance

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