Mortality associated with alternative policy options for primary care and the Mais Medicos (More Doctors) Program in Brazil: forecasting future scenarios
Mortality associated with alternative policy options for primary care and the Mais Medicos (More Doctors) Program in Brazil: forecasting future scenarios
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DOI：
10.26633/rpsp.2020.31
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发表时间：
2020-01-01
影响因子：
2.6
通讯作者：
Rasella, Davide
中科院分区：
文献类型：
--
作者：
Francesconi, Gabriel Vivas;Tasca, Renato;Rasella, Davide
目标。预测巴西家庭健康战略（Estrategia Saude da Familia） （ESF）覆盖范围变化的替代方案——由于财政紧缩措施和“更多医生”计划（PMM）的结束——对截至2030年5岁以下儿童死亡率（U5MRs）和70岁以下儿童死亡率（U70MRs）的影响。在2017-2030年期间，创建了5,507个巴西城市的综合队列。建立了市级微观模拟模型，并利用纵向数据对模型进行了验证。与维持目前的ESF覆盖相比，根据两种可能的紧缩情景预测了ESF覆盖的减少及其对acsc的u5和U70MRs的影响。采用固定效应纵向回归模型来解释长期趋势、人口和社会经济变化、与卫生保健相关的变量和项目持续时间的影响。与维持稳定的ESF覆盖率相比，由于紧缩措施和PMM终止导致ESF覆盖率下降，到2030年，u5和u70的平均mr将分别高出13.2%和8.6%。到2030年，PMM的结束将导致ACSCs的平均U5MR增加4.3%，ACSCs的U70MR增加2.8%。仅由于一直在PMM工作的古巴医生的退出而导致PMM覆盖率的减少，就会导致2030年U5MR增加3.2%，U70MR增加2.0%。由于紧缩措施，初级卫生保健覆盖面减少，以及计划生育的结束，可能导致巴西未来几年出现许多本可避免的成人和儿童死亡。
Objective. To forecast the impact of alternative scenarios of coverage changes in Brazil's Family Health Strategy (Estrategia Saude da Familia) (ESF)-due to fiscal austerity measures and to the end of the Mais Medicos (More Doctors) Program (PMM)-on overall under-5 mortality rates (U5MRs) and under-70 mortality rates (U70MRs) from ambulatory care sensitive conditions (ACSCs) up through 2030.Methods. A synthetic cohort of 5 507 Brazilian municipalities was created for the period 2017-2030. A municipal-level microsimulation model was developed and validated using longitudinal data. Reductions in ESF coverage, and its effects on U5MRs and U70MRs from ACSCs, were forecast based on two probable austerity scenarios, as compared to the maintenance of current ESF coverage. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, variables related to health care, and program duration effects.Results. In comparison to maintaining stable ESF coverage, with the decrease in ESF coverage due to austerity measures and PMM termination, the mean U5MR and U70MR would be 13.2% and 8.6% higher, respectively, in 2030. The end of PMM would be responsible for a mean U5MR from ACSCs that is 4.3% higher and a U70MR from ACSCs that is 2.8% higher in 2030. The reduction of PMM coverage due only to the withdrawal of Cuban doctors who have been working in PMM would alone be responsible for a U5MR that is 3.2% higher, and a U70MR that is 2.0% higher in 2030.Conclusions. Reductions in primary health care coverage due to austerity measures and the end of the PMM could be responsible for many avoidable adult and child deaths in coming years in Brazil.