Banca de DEFESA: LUCAS GOMES JARDIM

TWO TRIALS ON PAYMENT SYSTEMS FOR PERFORMANCE IN PRIMARY HEALTH CARE SERVICES

Pay for Performance; Primary Health Care; Service quality; “Previne Brasil”.

This dissertation consists of two independent essays that discuss the Pay for Performance (P4P)
in Primary Health Care. Both of the essays are based on the microeconomic rationale of Optimal
Contracts Theory to understand effective payment designs in healthcare systems. The first essay
introduces a microeconomic discussion underlying P4P in primary care services, in an
asymmetric economic environment of information and moral hazard. Afterwards, using
empirical literature, the results of the system practical implementation in different countries are
presented, examining what the results are and what factors condition the success of the contract.
It was possible to observe that the P4P models adopted in different countries are quite
heterogeneous, provoking controversial results, which makes the effectiveness of adopting the
scheme remain in an open discussion in the literature. However, it’s evident that the success is
directly related to the contract design. The second essay addresses the implementation of the
P4P in PHC in Brazil, based on the “Previne Brasil” program, and has an ex-ante evaluation of
this policy. The objective of this paper is to understand, from a theoretical structure of a
financing with a risk-sharing system in an environment with adverse selection, the Institutional
Design of the new federal financing model of primary care, in order to verify if it was elaborated
in order to ensure the effectiveness in the provision of services in Brazilian municipalities. The
results of the study suggest that the design of the P4P, within Previne Brasil, presents serious
vulnerabilities, and differs from what is recommended by the Theory of Optimal Contracts.