Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012).
Transition to universal primary health care coverage in Brazil: Analysis of uptake and expansion patterns of Brazil's Family Health Strategy (1998-2012).
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DOI：
10.1371/journal.pone.0201723
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Castro MC
中科院分区：
文献类型：
--
作者：
Andrade MV;Coelho AQ;Xavier Neto M;de Carvalho LR;Atun R;Castro MC
家庭健康战略是巴西的初级卫生保健计划，已在全国范围内推广，但其扩展在各个城市之间存在差异。我们调查是否有独特的城市特征可以解释 1998 年至 2012 年家庭健康战略的采用时间和扩展模式。我们根据家庭健康战略采用的相对速度和家庭健康战略覆盖范围扩展的模式将城市分为六组。我们收集了 2000 年和 2010 年 5,507 个城市的 11 项指标的数据，并评估了六组指标的差异，并绘制了这些数据以检查空间异质性。区分早期和晚期采用家庭健康战略的重要因素是医生的供应和人口密度。覆盖范围的持续扩大主要与人口规模、项目边际效益和医生供应有关。这种吸收在全国范围内广泛存在，各地区之间没有明显的模式，但在州和市一级却存在很大差异。巴西扩大初级卫生保健的经验为影响初级卫生保健普及的因素提供了三个教训。首先，筹资机制对于计划的实施至关重要，并且必须辅之以支持低密度地区初级保健医生供应的方法。其次，在较发达和较大的地区，主要挑战是缺乏追求全民保险的动力，特别是由于私人保险的可用性。第三，人口规模是保证覆盖范围长期可持续性的关键因素。
Family Health Strategy, the primary health care program in Brazil, has been scaled up throughout the country, but its expansion has been heterogeneous across municipalities. We investigate if there are unique municipal characteristics that can explain the timing of uptake and the pattern of expansion of the Family Health Strategy from years 1998 to 2012. We categorized municipalities in six groups based on the relative speed of the Family Health Strategy uptake and the pattern of Family Health Strategy coverage expansion. We assembled data for 11 indicators for years 2000 and 2010, for 5,507 municipalities, and assessed differences in indicators across the six groups, which we mapped to examine spatial heterogeneities. Important factors differentiating early and late adopters of the Family Health Strategy were supply of doctors and population density. Sustained coverage expansion was related mainly to population size, marginal benefits of the program and doctors’ supply. The uptake was widespread nationwide with no distinct patterns among regions, but highly heterogeneous at the state and municipal level. The Brazilian experience of expanding primary health care offers three lessons in relation to factors influencing diffusion of primary health care. First, the funding mechanism is critical for program implementation, and must be accompanied by ways to support the supply of primary care physicians in low density areas. Second, in more developed and bigger areas the main challenge is lack of incentives to pursue universal coverage, especially due to the availability of private insurance. Third, population size is a crucial element to guarantee coverage sustainability over time.
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影响因子：
2.8
作者：
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作者：
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