Greve Jane, Schattan Ruas Pereira Coelho Vera
KORA, Danish National Institute of Regional Governmental Research, Købmagergade 22, Copenhagen 1150, Denmark.
CEBRAP's Citizenship, Health and Development Team and Centre for Metropolitan Studies.
Health Policy Plan. 2017 Sep 1;32(7):923-933. doi: 10.1093/heapol/czw176.
As a means of dealing with shortcomings in the coverage, quality and efficiency of the public health care sector, several municipalities in the state of São Paulo, Brazil, have started to contract pre-certified non-profit or non-governmental organizations to take part in the delivery of health care services.This paper explores the impact of introducing these contracts in the primary health care sector. Using data on the 645 municipalities in the state of São Paulo and difference-in-differences methods, we estimate the effect of contracting out in the primary health care sector on various dimensions of mortality and health care use. The results show that implementation of the contracting out strategy significantly increases the number of primary health care appointments by approximately one appointment per user of the national health care system per year. Point estimates indicate a reducing effect on hospitalization for preventable diseases.
作为应对公共卫生保健部门覆盖范围、质量和效率方面缺陷的一种手段，巴西圣保罗州的几个市已开始与预先认证的非营利组织或非政府组织签约，让它们参与医疗服务的提供。本文探讨了在初级卫生保健部门引入这些合同的影响。利用圣保罗州645个市的数据和差分法，我们估计了初级卫生保健部门外包对死亡率和医疗保健使用各个维度的影响。结果表明，外包战略的实施显著增加了初级卫生保健预约的数量，每年全国医疗保健系统的每个用户大约增加一次预约。点估计表明对可预防疾病的住院治疗有减少作用。
