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.

Autor:	Russo LX; Department of Economics, Federal University of Grande Dourados, Dourados, Brazil leticia_xr@hotmail.com., Powell-Jackson T; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK., Maia Barreto JO; Oswaldo Cruz Foundation, Brasília, Brazil., Borghi J; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK., Kovacs R; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK., Gurgel Junior GD; Oswaldo Cruz Foundation, Recife, Brazil., Gomes LB; Department of Health Promotion, Federal University of Paraiba, Joao Pessoa, Brazil., Sampaio J; Department of Health Promotion, Federal University of Paraiba, Joao Pessoa, Brazil., Shimizu HE; Department of Collective Health, University of Brasilia, Brasilia, Brazil., de Sousa ANA; Ministry of Health, Brasilia, Brazil., Bezerra AFB; Department of Social Medicine, Federal University of Pernambuco, Recife, Brazil., Stein AT; Department of Public Health, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil., Silva EN; Faculty of Ceilandia, University of Brasilia, Brasilia, Brazil.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2021 Jul; Vol. 6 (7).
DOI:	10.1136/bmjgh-2021-005429
Abstrakt:	Background: Evidence 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. Methods: We 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. Results: The 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. Conclusion: We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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