Joana Raquel Raposo Dos Santos1,2, Hellen Geremias Dos Santos3, Carlos Manuel Matias Dias4,5, Alexandre Dias Porto Chiavegatto Filho6. 1. School of Public Health, University of São Paulo, São Paulo, Brazil. joanasantos@usp.br. 2. Department of Epidemiology, National Health Institute Doctor Ricardo Jorge, Lisbon, Portugal. joanasantos@usp.br. 3. Cargos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Paraná, Brazil. 4. Department of Epidemiology, National Health Institute Doctor Ricardo Jorge, Lisbon, Portugal. 5. Public Health Research Center, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal. 6. School of Public Health, University of São Paulo, São Paulo, Brazil.
Abstract
OBJECTIVES: The More Doctors Program (MDP) is an ongoing Brazilian policy that aims to improve healthcare by providing physicians to the most vulnerable municipalities. We aimed to measure the impact of MDP in mortality and infant mortality rate, the proportion of live births with low weight, prenatal appointments, childbirths at first and fifth min Apgar, public health investment and immunization in Brazil. METHODS: Municipal health indicators were collected before and after the intervention (2012 and 2015). Effects were measured by applying propensity score matching with difference-in-differences. RESULTS: Our findings show that infant mortality presented the highest improvement during the period (a decrease in 11 infant deaths per 1000 live births, p < 0.01). A significant effect, albeit smaller, was also found for the age-standardized total mortality (a decrease in five deaths per 10,000 residents), proportion of children with Apgar score lower than 8 in the fifth min and children with low birth weight. CONCLUSIONS: MDP contributed to improve important health indicators, highlighting the importance of a doctor in remote areas of Brazil.
OBJECTIVES: The More Doctors Program (MDP) is an ongoing Brazilian policy that aims to improve healthcare by providing physicians to the most vulnerable municipalities. We aimed to measure the impact of MDP in mortality and infant mortality rate, the proportion of live births with low weight, prenatal appointments, childbirths at first and fifth min Apgar, public health investment and immunization in Brazil. METHODS: Municipal health indicators were collected before and after the intervention (2012 and 2015). Effects were measured by applying propensity score matching with difference-in-differences. RESULTS: Our findings show that infant mortality presented the highest improvement during the period (a decrease in 11 infant deaths per 1000 live births, p < 0.01). A significant effect, albeit smaller, was also found for the age-standardized total mortality (a decrease in five deaths per 10,000 residents), proportion of children with Apgar score lower than 8 in the fifth min and children with low birth weight. CONCLUSIONS: MDP contributed to improve important health indicators, highlighting the importance of a doctor in remote areas of Brazil.
Entities:
Keywords:
Mais médicos; Propensity score; Public health; Public policy
Authors: Melissa M Garrido; Amy S Kelley; Julia Paris; Katherine Roza; Diane E Meier; R Sean Morrison; Melissa D Aldridge Journal: Health Serv Res Date: 2014-04-30 Impact factor: 3.402