Banca de DEFESA: RAFAEL DAMASCENO DE BARROS
Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.DISCENTE : RAFAEL DAMASCENO DE BARROS
DATA : 08/07/2021
HORA: 09:00
LOCAL: https://www.youtube.com/user/labvideoisc
TÍTULO:
Evolution, results and efficiency of primary health care in Brazil.
PALAVRAS-CHAVES:
Primary Health Care. Health Assessment. Efficiency. Morbimortality Indicators
PÁGINAS: 186
GRANDE ÁREA: Ciências da Saúde
ÁREA: Saúde Coletiva
RESUMO:
The study aimed to evaluate the evolution, results and efficiency of Primary Health Care in Brazil. The analysis of evolution considered elements of organization and structure, service provision and results of primary care in Brazilian municipalities between 2002 and 2019. Negative binomial regressions of panel data with fixed effect were used to investigate the effect of the population size of municipalities on the said elements. It was found that municipalities with smaller population size had higher per capita expenditure, coverage and provision of services. Municipalities with a larger population had a lower morbidity and mortality due to conditions sensitive to primary care. Based on these results, the association of socioeconomic, demographic and municipal health system structure factors with morbidity and mortality due to PHC-sensitive conditions in Brazil was investigated. For this purpose, negative binomial regressions of panel data with fixed effect were performed. The results indicated that users who lived in cities with worse socioeconomic conditions had a higher risk of dying and especially of being hospitalized for conditions sensitive to primary care. Greater access to computed tomography and ultrasound examinations also contributed to reducing the risk of death or hospitalization for the same conditions. Still on the health outcomes of users and the population, the impact of elements of the organization, structure and provision of primary care services with morbidity and mortality due to conditions sensitive to primary care was investigated. To this end, negative binomial regressions of panel data with a fixed effect were also performed, controlled by socioeconomic factors, population size and the structure of municipal health systems. Users who lived in municipalities with greater coverage or provision of services had a lower risk of death and hospitalization for conditions sensitive to primary care. Per capita expenditure was not associated with mortality, but acted to reduce the risk of hospitalizations. The effect of organization, structure, and service provision was stronger on admissions than on mortality. Finally, the efficiency of processes and results of primary care in Brazilian municipalities between 2008 and 2019 was evaluated using the Data Envelopment Analysis technique based on slacks, with product orientation and variable returns to scale. To analyze the environmental and non-discretionary factors that were related to efficiency, a second-stage data envelopment analysis was performed using a truncated bootstrap regression. The average efficiency of the municipalities was 66% and 50% for processes and results, respectively. That is, with the same levels of per capita expenditure and number of teams per 3,450 inhabitants, it would be possible to expand the provision of services and reduce deaths and hospitalizations, by reducing the inefficiency of the primary attention. Municipalities with smaller population size were more efficient in processes, showing, on average, a higher productivity per team in the researched period. Municipalities with worse socioeconomic conditions were more efficient in processes and less efficient in results. The presence of tomographs, ultrasound devices and a greater number of medical appointments in specialized care per inhabitant contributed to increase the efficiency of the results. Greater financial investment in health with the municipalities' own resources was also associated with an increase in the efficiency of results. The findings of this thesis reinforce the hypothesis that the context in which each municipality is inserted impacts its efficiency, therefore the actors involved with the organization and planning of primary care must take these aspects into account, strengthening equity in decision-making, seeking , finally, to reduce the inefficiency of primary health care in Brazilian municipalities.
MEMBROS DA BANCA:
Externa à Instituição - GABRIEL ALVES DE SAMPAIO MORAIS
Interno - 2188285 - LUIS EUGENIO PORTELA FERNANDES DE SOUZA
Interno - 118.180.505-87 - MAURICIO LIMA BARRETO - UFBA
Interna - 284.048.585-00 - ROSANA AQUINO GUIMARAES PEREIRA - UFBA
Presidente - 021.790.245-68 - SEBASTIAO ANTONIO LOUREIRO DE SOUZA E SILVA - UFBA
Externo ao Programa - 1321461 - VINICIUS DE ARAUJO MENDES