Impact of the Programa Mais medicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities
Impact of the Programa Mais medicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities
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DOI：
10.1186/s12913-020-05716-2
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发表时间：
2020-09-15
影响因子：
2.8
通讯作者：
Millett, Christopher
中科院分区：
文献类型：
--
作者：
Hone, Thomas;Powell-Jackson, Timothy;Millett, Christopher
背景投资于卫生人力资源对于实现全民卫生保健和可持续发展目标至关重要。“更多医生方案”（PMM）提供了1.7万名医生，主要来自古巴，从事巴西的初级保健工作。本研究评估了PMM医生分配到城市是否符合规划标准以及对可适应死亡率的相关影响。方法采用差异中差异回归分析，利用2008-2017年5565个城市PMM引入的变化，研究项目对医生密度和适合医疗保健的死亡率的影响。在引入PMM之前，探讨了医生分配标准和城市医生密度方面的效果异质性。结果从2013年开始，PMM与PMM签约的初级保健医生增加有关，每10万人增加15.1名。然而，对现有初级保健医生的大规模替代只导致每10万人中净增加5.7人。由于PMM医生的分配较低和更大的替代效应，优先城市的PMM医生和初级保健医生总数的增长都较低。PMM每年可使死亡率降低1.06 / 10万（95%置信区间：1.78 - 0.34），在优先分配医生的城市和在方案实施前医生密度低的地方，效益更大。结论由于医生被广泛分配到非重点地区和局部替代效应，PMM的潜在健康效益被削弱。旨在加强人力资源管理的政策应制定和执行以需求为基础的资源分配标准。
Background Investing in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. ThePrograma Mais Medicos(PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality. Methods Difference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008-2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction. Results After starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of - 1.06 per 100,000 (95%CI: - 1.78 to - 0.34) annually - with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation. Conclusions PMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.