A comparative analysis of the implementation of the Mais Médicos (More Doctors) Program in municipalities in the State of Rio Grande do Sul, Brazil

Miranda, Alcides Silva de; Melo, Diego Azevedo

doi:10.1590/1413-81232015219.18522016

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Article • Ciênc. saúde colet. 21 (09) • Sept 2016 • https://doi.org/10.1590/1413-81232015219.18522016 copy

A comparative analysis of the implementation of the Mais Médicos (More Doctors) Program in municipalities in the State of Rio Grande do Sul, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Mais Médicos (More Doctors) Program has led to an increase in the number of doctors and medical treatment in primary health care services across Brazil. This article presents the results of a case-control study of groups of municipalities based on secondary data sources. It aims to explore and discuss a set of indicators of primary health care service delivery. An improvement in performance against structural indicators was observed in municipalities where the program was implemented. With respect to the outcome indicators, a slight improvement in service delivery was observed in municipalities where the program was implemented. However, no difference was observed in impacts between the case and control municipalities. These results may have been influenced by the fact that the program has only been underway for a limited time, by underreporting of doctors by the National Health Facilities Register (CNES, acronym in Portuguese), and the predominantly substitutive nature of the allocation of medical professionals under the program in the selected municipalities.

Key words
Regional medical programs; Foreign medical graduates; Distribution of doctors; Primary Health Care doctors; Primary Health Care

Aggregated municipalities and population categories		Aggregated municipalities
Aggregated municipalities and population categories	Macro Heath Regions	Cases (with PMM)	Controls (no PMM)	Total	%
A1- Fewer than 10,000 inhabitants	7	34	34	68	62.9
A2- More than 10,000 and fewer than 25,000 inhab.	7	9	9	18	16.6
A3- More than 25,000 and fewer than 50,000 inhab.	7	6	6	12	11.1
A4- More than 50,000 and fewer than 100,000 inhab.	6	3	3	6	5.5
A5- More than 100,000 inhab.	4	2	2	4	3.9
Total		54	54	108	100

Structural Indicators

Outcome indicators

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Coverage rate by Community Health Agents per 750 inhabitants (standard of the National ABS policy – PNAB)
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Coverage rate by teams from the Family Health Strategy per 4,000 inhabitants (standard of the National ABS policy – PNAB)
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Per capita state and federal transfers (in BRL$) for costs of the ABS
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Per capita federal transfers (in BRL$) for costs of the Family Health Strategy (Lower Care Level, variable fraction).

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proportion of admissions for sensitive causes in the ABS/APS,
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admission rate for Acute Respiratory Infection (ARI) in under-fives,
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hospitalization rate for Acute Diarrhea in under-fives,
–
Rate of admissions for ambulatory care per habitant/year
–
Rate of admissions for complications relating to Diabetes Mellitus.
–
Rate of admissions for Cerebral Vascular Accidents (CVA).
–
Rate of admissions for Cardiac Congestive Failure
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Incidence rate for positive pulmonary tuberculosis.

Aggregated municipalities and population categories	% Dif. 2010-2012 Doctors	% Dif. 2013-2014 Doctors	% Dif. 2010-2012 Doctors ABS/APS-SUS	% Dif. 2013-2014 Doctors ABS/APS-SUS
A1- Fewer than 10,000 inhabitants	1.4	-9.7	-17.2	-31.7
A2- More than 10,000 and fewer than 25,000 inhab.	-2.4	9.5	-22	5.9
A3- More than 25,000 and fewer than 50,000 inhab.	4.9	-3.4	-30.9	-10.6
A4- More than 50,000 and fewer than 100,000 inhab.	-10.4	6.5	11.5	-19.0
A5- More than 100,000 inhab.	3.0	-14.8	3.1	-18.3

Aggregated municipalities/years		A1		A2		A3		A4		A5
Aggregated municipalities/years		Case	Control	Case	Control	Case	Control	Case	Control	Case	Control
Coverage rate by Community Health Agents per 750 inhabitants
	2010	1.1	1.6	0.8	1.1	0.9	0.9	0.2	0.7	0.4	0.5
	2011	1.1	1.6	0.8	1.2	0.8	0.8	0.2	0.6	0.5	0.5
	2012	1.2	1.7	0.8	1.4	0.9	1.0	0.3	0.6	0.5	0.6
	2013	0.9	1.6	0.8	1.3	0.8	0.9	0.3	0.6	0.5	0.5
	2014	1.3	1.6	0.8	1.3	0.8	0.9	0.3	0.7	0.4	0.5
Coverage rate by teams from the Family Health Strategy per 4,000 inhabitants
	2010	1.0	1.2	0.6	0.8	0.7	0.8	0.1	0.5	4.0	0.4
	2011	1.0	1.2	0.6	1.0	0.8	0.8	0.2	0.5	0.4	0.5
	2012	1.0	1.2	0.6	1.0	0.8	0.8	0.2	0.5	0.4	0.5
	2013	1.0	1.2	0.6	1.0	0.8	0.8	0.2	0.6	0.6	0.6
	2014	1.4	1.4	1.0	1.2	0.9	1.0	0.3	0.6	0.7	0.7
Rate of admissions for ambulatory care per habitant/year
	2010	3.8	2.2	1.4	2.1	1.1	2.6	1.5	1.3	1.2	1.8
	2011	3.6	3.2	1.5	1.9	2.2	3.2	1.5	2.1	1.2	2.1
	2012	2.4	3.7	1.5	1.4	1.2	2.1	1.3	1.1	1.0	2.1
	2013	2.5	2.3	2.1	4.6	1.2	3.7	1.5	1.0	1.0	1.8
	2014	4.5	3.1	1.3	4.2	1.5	2.9	2.3	1.2	1.0	2.2

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[1] Collaborations

AS Miranda and DA Melo participated in the elaboration of the research project, data collection, processing and analysis, and in the drafting and revision of the present article.