RESUMEN

This paper investigates the role of primary healthcare in mitigating the consequences of the COVID-19 pandemic, focusing on the Brazilian Family Health Strategy (ESF) as a case study. ESF is Brazil's major primary care initiative, with prior evidence indicating its effectiveness in improving various health outcomes. The COVID-19 pandemic submitted the Brazilian healthcare system to a rigorous and unprecedented stress test, whose repercussions are still under study. Using comprehensive administrative microdata from 2016 to 2022 encompassing dimensions related to mortality, healthcare service, supply of family health teams, and vaccination coverage, our empirical strategy accounts for heterogeneous effects based on program intensity and pandemic evolution of the 5570 Brazilian municipalities. Our findings reveal that municipalities with high-intensity of ESF coverage (i.e. stronger primary care) experienced 347.93 (95% CI: 289.04, 406.81) fewer COVID-19 and cardiorespiratory deaths per million inhabitants throughout the pandemic period, compared to those in low-intensity ESF areas, despite sharing similar profiles of deaths from respiratory and cardiovascular causes. Among the channels contributing to this relative performance, high-intensity ESF municipalities were found to engage in more home-based primary care visits and health promotion activities while maintaining a similar supply of community health workers. Additionally, they achieved higher vaccination coverage, and these effects were more pronounced in areas with greater ESF presence, emphasising the importance of primary care coverage. In conclusion, our findings underscore the relevance of strong primary care in mitigating the consequences of the pandemic and addressing post-pandemic health challenges.

RESUMEN

This paper assesses whether Brazilian primary health care is worth it in the long-run by estimating the accumulated costs and benefits of its flagship, the Family Health Strategy program (ESF). We employ an alternative strategy centered on years of exposure to the program to incorporate its dynamics. We also account for the program's heterogeneity with respect to the remuneration of ESF health teams and the intensity of coverage across Brazilian municipalities, measure by the number of people assisted by each ESF team, on average. To address heterogeneity in professional earnings, this paper employs, for the first time, a dataset containing the remuneration of professionals allocated to all ESF teams nationwide. The benefits are measured by the avoided deaths and hospitalizations due to causes sensitive to primary care. Results suggest that the net monetary benefit of the program is positive on average, with an optimum time of exposure of approximately 16 years. Significant heterogeneities in cost-benefit results were found since costs outweigh benefits in localities where the coverage is low intensive. On the other hand, the benefits outweigh the costs by 22.5% on average in municipalities with high intensive coverage.

Asunto(s)

RESUMEN

This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct impact of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25-64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discuss heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension and diabetes. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasize the role of having sufficient health teams to attend to the population.

Asunto(s)

RESUMEN

BACKGROUND: Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. METHODS: The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. RESULTS: Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between - 2.16 and - 2.18 percentage points), kidney failure (between - 1.01 and - 1.19 p.p.), and arterial hypertension (between - 1.48 and - 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between - 1.8 and - 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. CONCLUSIONS: The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.

Asunto(s)