Provider Supply, Utilization, and Infant Health: Evidence from a Physician Distribution Policy

Carrillo, Bladimir; Féres, José Gustavo

doi:10.1257/pol.20170619

Cited by 21 publications

(36 citation statements)

References 65 publications

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“…This evidence suggests that the matched sample is much more similar than the unmatched one on these observable characteristics. We argue that this identification strategy is the best to analyse the effects of the programme, as done in other past studies 17 18…”

Section: Methodsmentioning

confidence: 83%

“…Yet, there exist few rigorous quantitative evaluations, which attempted to estimate the causal impacts of the MDP on health indicators. Carrillo and Feres17 showed that the programme increased doctor visits and led to greater utilisation of doctors for prenatal care. However, they do not find evidence of gains in infant health, including birth weight, gestation and mortality.…”

Section: Introductionmentioning

confidence: 99%

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Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil

et al. 2019

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BackgroundBrazil faces huge health inequality challenges since not all municipalities have access to primary care physicians. The More Doctors Programme (MDP), which started in 2013, was born out of this recognition, providing more than 18 000 doctors in the first few years. However, the programme faced a restructuring at the end of 2018.MethodsWe construct a panel municipality-level data between 2008 and 2017 for 5570 municipalities in Brazil. We employ a difference-in-differences empirical approach, combined with propensity score matching, to study the impacts of the programme on hospitalisations for ambulatory care sensitive conditions and its costs. We explore heterogeneous impacts by age of the patients, type of admissions, and municipalities that were given priority.FindingsThe MDP reduced ambulatory admissions by 2.9 per cent (p value <0.10) and the costs by 3.7 per cent (p value <0.01) over the mean. The reduction was driven by infectious gastroenteritis, bacterial pneumonias, asthma, kidney and urinary infections, and pelvic inflammatory disease. The results held on the subsample of municipalities targeted by the programme. By comparing the benefits of the programme from the reduction in the costs of ambulatory admissions to the total financial costs of the MDP, the impacts allowed the government to save at least BRL 27.88 (US$ 6.9 million) between 2014 and 2017.ConclusionAddressing inequalities in the distribution of the medical workforce remains a global challenge. Our results inform the discussion on the current strategy adopted in Brazil to increase access to primary healthcare in underserved areas.

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Section: Methodsmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil

et al. 2019

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“…In prior work,Buchmueller et al (2016) find evidence that dental demand shocks after expanded Medicaid coverage were accommodated in part by supply increases by mid-level providers Carrillo and Feres (2018). provide further evidence that physicians and nurses may be close substitutes for the provision of some services in their study of physician supply policy in Brazil.6He et al (2015) have similar findings using changes in county unemployment rates.…”

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confidence: 78%

The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

Carey

Miller

Wherry

2020

American Economic Journal: Applied Economics

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Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population. (JEL G22, H51, I13, I18, I38)

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“…These models were used to identify associations between PMM introduction and changes in outcomes over time by comparing changes in mortality rates between areas that received the PMM and those that did not before and after PMM implementation. Existing studies examining hospitalisations and healthcare utilisation have employed similar analytical strategies and demonstrate the appropriateness of these approaches and validity of underlying assumptions [20,21,28,29].…”

Section: Statistical Analysesmentioning

confidence: 99%

Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

Hone

Powell‐Jackson

Santos

et al. 2020

BMC Health Serv Res

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Background Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. Methods Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. Results After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. Conclusions PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

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Provider Supply, Utilization, and Infant Health: Evidence from a Physician Distribution Policy

Cited by 21 publications

References 65 publications

Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil

Addressing inequalities in medical workforce distribution: evidence from a quasi-experimental study in Brazil

The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities

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