Financial impact of the change in the vulnerability profile of More Doctors Program

Denise de Fátima Barros Cavalcante

Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Pós-Doutoranda em Odontologia em Saúde Coletiva. Piracicaba, SP, Brasil

Carolina Vitti Domingues

Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Programa de Pós-Graduação em Odontologia. Piracicaba, SP, Brasil

Diego Roberto Meloni

Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Programa de Pós-Graduação em Saúde Pública. Ribeirão Preto, SP, Brasil

Frederico Machado de Almeida

Faculdade de Ciências Médicas da Santa Casa de São Paulo. São Paulo, SP, Brasil

Livia Fernandes Probst

Universidade Federal de Mato Grosso do Sul. Faculdade de Odontologia de Campo Grande. Departamento de Saúde Coletiva. Campo Grande, MS, Brasil

Yuri Wanderley Cavalcanti

Universidade Federal da Paraíba. Centro de Ciências da Saúde. Departamento de Odontologia Social. Joao Pessoa, PB, Brasil

Marcelo de Castro Meneghim

Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Social. Piracicaba, SP, Brasil

Antonio Carlos Pereira

Universidade Estadual de Campinas. Faculdade de Odontologia de Piracicaba. Departamento de Odontologia Social. Piracicaba, SP, Brasil

Correspondence: Denise de Fátima Barros Cavalcante Faculdade de Odontologia de Piracicaba Avenida Limeira, 901 13414-903 Piracicaba, SP, Brasil E-mail: dradenisecavalcante@gmail.com

Authors’ Contribution: Study design and planning: DFBC. Data collection, analysis and interpretation: ACP, YWC, DRM, FMA. Preparation or review of the manuscript: DFBC, CVD, LFP, MCM. Approval of the final version and public responsibility for the content of the article: all authors.

Methodology for costing
Ministry of Health:
Duration of the PMMB: (a) scholarship related to the payment of the professional; and (b) decrease in the transfer values for the eSF.
After non-replenishment: (a) non-payment of scholarship; and (b) increase in the transfer values to the eSF.
Municipalities
Duration of the PMMB: (a) money received by the MH for the project; (b) food and rent by the municipalities; and (c) decrease in the transfer values for the eSF.
After non-replenishment: (a) hiring of physicians (market value equal to the value of the project grant) + labor charges; and (b) increase in the transfer values to the FHS.

Dependence of PMMB in municipalities (%)	Nº of municipalities by Vulnerability Indicator*
	Types of line
	1	2	3	4	5	6	Overall Total
0–20	53	39	26	7	1	1	127
20–40	27	50	17	11	4	6	115
40–60	16	36	5	25	-	7	89
60–80	-	6	3	2	-	1	12
80–100	1	8	-	16	-	5	30
Overall total	97	139	51	61	5	20	373

	Cycle (month / year)	Number of physicians per cycle	MH (R$)	Municipality (R$)
	MDP ceiling (January/2019)	2.533	40,236,064.80	−8,612,200.00
	9th cycle (vacancies until March/2019)	2.165	35,549,364.00	10,452,099.85
	10th cycle (vacancies until April/2019)	2.107	34,810,699.20	11,061,462.33
	11th cycle (vacancies until June/2019)	2.106	34,797,963.60	11,071,968.58
	12th cycle (vacancies until August/2019)	2.084	34,517,780.40	11,303,106.07
	13th cycle (vacancies until February/2020)	1.909	32,289,050.40	13,141,699.75
	11th cycle (vacancies until June/2019)	1.484	26,876,420.40	17,606,855.83
	15th cycle (vacancies until January/2021)	1.427	26,150,491.20	18,205,712.06
	16th cycle (vacancies until December/2021)	546	14,930,427.60	27,461,717.96
	17th cycle (vacancies until March/2022)	320	12,052,182.00	29,836,130.36
	Total costs (39 months)		1,124,135,514.00	593,612,104.77
	Financial impact on municipalities between January/2019 and March / 2022			−929,487,904.77
Sensitivity analysis	More pessimistic scenario (+30%)			−1,208,334,276.20
Sensitivity analysis	More optimistic scenario (-30%)			650,641,533.34‬
	Financial impact on MH between January/2019 and March/2022			445,071,013.20
Sensitivity analysis	More pessimistic scenario (+30%)			578,592,317.16
Sensitivity analysis	More optimistic scenario (-30%)			311,549,709.24

MH investment	Physicians’ scholarship (PS)	Difference in values in the transfer of the variable PCF to the eSF (PCF_dif)	Expenditure on references (Ref.)*	Variable PCF with PMMB physician (PCF_PMMB)
	R$ 11,865.60	R$ 3,130.00 (R$ 7,130.00-R$ 4,000.00)	R$ 6,500. 00 (n=1/central) and R$ 6,000. 00 (n= 7/SP decentralized)	R$ 4,000.00
Municipalities’ budget	Medical salary with employment charges (Physician Wage)	Difference in values in the transfer of the variable PCF to the eSF (PCF_dif)	Rent (Rent.)	Feeding (Food.)
	R$ 20,236.25	R$ 3,130.00	R$ 2,000.00	R$ 600.00

Gross	R$ 15.809,57
Brazilian National Social Security Institute (INSS)	R$ 642.34
Income Tax (A)	R$ 3,301.63
Net	R$ 11,865.60
INSS-employer quota (monthly)	R$ 3,161.91
Brazilian Government Severance Indemnity Fund for Employees (monthly)	R$ 1,264.77
Holidays + 1/3	R$ 21,079.43
13th salary	R$ 15,809.57
Notice	R$ 15,809.57
INSS-employer quota (notice)	R$ 3,161.91
FGTS (notice)	R$ 1,264.77
INSS-employer quota (holidays + 1/3)	R$ 4,215.89
FGTS (13th salary)	R$ 1,264.77
Monthly total	R$ 20,236.25
Annual total for the employer, already including termination	R$ 285,204.64

Brasil

MH	1st baseline: January 2019 (Ref. + N physicians * Scholarship + N physicians * 4,000) From the 3rd line: March 2019 {Ref. + [N physicians PMMB * scholarship] + [N physicians * PCF_PMMB] + [(N baseline physicians PMMB – N physicians current month)* PCF_dif]}
Municipalities	1st baseline: January 2019 {[N physicians * (Food. + Rent.)] + (N doctors * PCF_PMMB)} From the 3rd line: March 2019 {[N physicians PMMB * (Food. Rent.)] + [(N baseline physicians – N physicians current month] * (Physician wage) – [(N baseline physicians – N physicians current month] * (PCF_PMMB + PCF_dif)}