在巴西偏远和条件艰苦地区提供医生服务的成本

Cost of providing doctors in remote and vulnerable areas: in Brazil.

作者信息

da Silva Everton Nunes, Ramos Maíra Catharina, Santos Wallace, Rasella Davide, Oliveira Aimê, Santos Leonor Maria Pacheco

机构信息

University of Brasilia, Brasília, Federal District, Brazil.

Oswaldo Cruz Fo undation, Rio de Janeiro, Brazil.

出版信息

Rev Panam Salud Publica. 2018 May 4;42:e11. doi: 10.26633/RPSP.2018.11. eCollection 2018.

Abstract

OBJECTIVE

To evaluate the Programa Mais Médicos (More Doctors Program; PMM) in Brazil by estimating the proportional increase in the number of doctors in participating muni-cipalities and the program costs, stratified by cost component and funding source.

METHODS

Official data from the 2013 edition of Demografia Médica no Brasil (Medical Demography in Brazil) was used to estimate the number of doctors prior to PMM. The number of doctors at the end of the fourth PMM recruiting cycle (July 2014) was obtained from the Ministry of Health. Cost components were identified and estimated based on PMM legislation and guidelines. The participating municipalities were chosen based on four criteria, all related to vulnerability.

RESULTS

The PMM provided an additional 14 462 physicians to highly vulnerable, remote areas in 3 785 municipalities (68% of the total) and 34 Special Indigenous Sanitary Districts. There was a greater increase of physicians in the poorest regions (North and Northeast). The estimated annual cost of US$ 1.1 billion covered medical provision, continuing education, and supervision/mentoring. Funding was largely centralized at the federal level (92.6%).

CONCLUSION

The cost of PMM is considered relatively moderate in comparison to its potential benefits for population health. The greater increase of doctors for the poorest and most vulnerable met the target of correcting imbalances in health worker distribution. The PMM experience in Brazil can contribute to the debate on reducing physician shortages.

摘要

目的

通过估计参与项目的各市医生数量的比例增长以及项目成本(按成本构成和资金来源分层),对巴西的“更多医生计划”(PMM)进行评估。

方法

使用《巴西医学人口统计学》2013年版的官方数据来估计PMM实施前的医生数量。第四轮PMM招募周期结束时(2014年7月)的医生数量来自卫生部。根据PMM的立法和指南确定并估计成本构成。参与项目的各市是根据四个与脆弱性相关的标准选定的。

结果

PMM为3785个市(占总数的68%)以及34个特别土著卫生区的高度脆弱偏远地区额外提供了14462名医生。最贫困地区(北部和东北部)的医生增长幅度更大。估计每年11亿美元的成本涵盖医疗服务、继续教育以及监督/指导。资金主要集中在联邦一级(92.6%)。

结论

与对人群健康的潜在益处相比,PMM的成本被认为相对适中。最贫困和最脆弱地区医生数量的更大增长实现了纠正卫生工作者分布不均衡的目标。巴西的PMM经验有助于关于减少医生短缺问题的辩论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/957f/6385704/4193ae8e4102/rpsp-42-e11-g001.jpg

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