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Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil.
de Medeiros, Olívia Lucena; Barreto, Jorge Otávio Maia; Harris, Matthew; Russo, Letícia Xander; da Silva, Everton Nunes.
Afiliação
  • de Medeiros OL; Graduate Program in Public Health, University of Brasilia, Brasília, Brazil.
  • Barreto JOM; Ministry of Health, Brasília, Brazil.
  • Harris M; Graduate Program in Public Health, University of Brasilia, Brasília, Brazil.
  • Russo LX; Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
  • da Silva EN; School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom.
PLoS One ; 15(10): e0240631, 2020.
Article em En | MEDLINE | ID: mdl-33057414
BACKGROUND: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. OBJECTIVE: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. METHOD: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). RESULTS: The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. CONCLUSION: PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidado Pré-Natal / Atenção Primária à Saúde / Reembolso de Incentivo / Cuidado do Lactente / Programas Nacionais de Saúde Tipo de estudo: Evaluation_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Infant / Newborn / Pregnancy País/Região como assunto: America do sul / Brasil Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cuidado Pré-Natal / Atenção Primária à Saúde / Reembolso de Incentivo / Cuidado do Lactente / Programas Nacionais de Saúde Tipo de estudo: Evaluation_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Female / Humans / Infant / Newborn / Pregnancy País/Região como assunto: America do sul / Brasil Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos