Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions. (December 2020)

• Record Type: Journal Article
• Authors: Özçelik, Ece A.; Massuda, Adriano; McConnell, Margaret; Castro, Marcia C.
• Is Part Of: SSM - population health. Volume 12(2020)
• Publication Date: 2020-12
• Subjects: Brazil -- Primary healthcare -- More doctors program -- Physician recruitment -- Family health strategy; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; 362.105
• DOI: 10.1016/j.ssmph.2020.100695
• Languages: English
• ISSNs: 2352-8273

Abstract

Abstract: Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of −1.47 (95%CI: −4.04, 1.10) for hospitalizations for cerebrovascular disease and −1.20 (95%CI: −5.50, 3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was −0.50 (95%CI: −2.94, 1.95) in the year of program introduction, −5.21 (95%CI: −9.43, -0.99) and −8.21 (95%CI: −13.68, -2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil. Highlights: Globally, cardiovascular diseases are the leading cause of disease burden and death. We study the impact of the More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We find an inverse association between MDP and hospitalizations due to cerebrovascular disease and hypertension. We show that the beneficial effects of MDP on cerebrovascular disease increased over time.