Evolução, resultados e eficiência da atenção primária à saúde no Brasil.

Abstract

The study aimed to evaluate the evolution, results and efficiency of Primary Care for Health in Brazil. The analysis of evolution considered elements of organization and structure, provision of services and results of primary care in Brazilian municipalities between 2002 and 2019. Negative binomial panel data regressions with fixed effects were used to investigate the effect of the population size of the municipalities on the aforementioned elements. He was found that municipalities with a smaller population size had higher expenditure per capita, coverage and provision of services. Municipalities with the largest population size had lower morbidity and mortality due to conditions sensitive to primary care. About these results, the association of socioeconomic, demographic and social factors was investigated structure of municipal health systems with morbidity and mortality due to conditions sensitive toAPS in Brazil. To this end, negative binomial regressions of panel data were carried out with fixed effect. The results indicated that users who lived in municipalities with worse socioeconomic conditions had a higher risk of death and especially of hospitalization due to conditions sensitive to primary care. Greater access to tomography exams computerized imaging and ultrasound also contributed to reducing the risk of death or hospitalizations for the same conditions. Still on the health results of users and population, the impact of elements of the organization, structure and provision of primary care services with morbidity and mortality due to care-sensitive conditions primary. This end, negative binomial regressions of panel data were also carried out with a fixed effect, controlled by socioeconomic factors, population size and structure of municipal health systems. Users who lived in municipalities with greater coverage or provision of services had a lower risk of death and hospitalization for conditions sensitive to primary attention. Per capita expenditure was not associated with mortality, but acted to reduce the risk of hospitalizations. The effect of the organization, structure and provision of services was more stronger on hospitalizations than on mortality. Finally, the efficiency of processes and results of primary care in Brazilian municipalities between 2008 and 2019 using the Data Envelopment Analysis technique based on slacks, with guidance to products and variable returns to scale. To analyze environmental and non-discretionary factors that were related to efficiency, data envelopment analysis was performed on second stage from a truncated regression with bootstrap. The average efficiency of municipalities was 66% and 50% for processes and results respectively. That is, with the same levels of per capita expenditure and number of teams per 3,450 inhabitants, it would be possible expand the provision of services and reduce deaths and hospitalizations, by reducing the inefficiency of the primary attention. Municipalities with a smaller population size were more efficient in processes, demonstrating on average greater productivity per team in the period researched. Municipalities with worse socioeconomic conditions were more efficient in processes and less efficient in results. The presence of CT scanners, ultrasound and a greater number of medical visits from specialized care through inhabitant contributed to increasing the efficiency of results. Greater financial investment in health with the municipalities' own resources was also associated with an increase in results efficiency. The findings of this thesis reinforce the hypothesis that the context in which each municipality is inserted impacts its efficiency, therefore the actors involved with the organization and planning of primary care, must take into account such aspects, strengthening equity in decision-making, ultimately seeking to reduce the inefficiency of primary health care in Brazilian municipalities.