Francesconi Gabriel Vivas, Tasca Renato, Basu Sanjay, Rocha Thiago Augusto Hernandes, Rasella Davide
Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization BrasíliaDistrito Federal Brazil Pan American Health Organization/World Health Organization, Brasília, Distrito Federal, Brazil.
Center for Population Health Sciences School of Medicine, Stanford University StanfordCalifornia United States of America Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California, United States of America.
Rev Panam Salud Publica. 2020 Mar 31;44:e31. doi: 10.26633/RPSP.2020.31. eCollection 2020.
To forecast the impact of alternative scenarios of coverage changes in Brazil's Family Health Strategy (Estratégia Saúde da Família) (ESF)-due to fiscal austerity measures and to the end of the Mais Médicos (More Doctors) Program (PMM)-on overall under-5 mortality rates (U5MRs) and under-70 mortality rates (U70MRs) from ambulatory care sensitive conditions (ACSCs) up through 2030.
A synthetic cohort of 5 507 Brazilian municipalities was created for the period 2017-2030. A municipal-level microsimulation model was developed and validated using longitudinal data. Reductions in ESF coverage, and its effects on U5MRs and U70MRs from ACSCs, were forecast based on two probable austerity scenarios, as compared to the maintenance of current ESF coverage. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, variables related to health care, and program duration effects.
In comparison to maintaining stable ESF coverage, with the decrease in ESF coverage due to austerity measures and PMM termination, the mean U5MR and U70MR would be 13.2% and 8.6% higher, respectively, in 2030. The end of PMM would be responsible for a mean U5MR from ACSCs that is 4.3% higher and a U70MR from ACSCs that is 2.8% higher in 2030. The reduction of PMM coverage due only to the withdrawal of Cuban doctors who have been working in PMM would alone be responsible for a U5MR that is 3.2% higher, and a U70MR that is 2.0% higher in 2030.
Reductions in primary health care coverage due to austerity measures and the end of the PMM could be responsible for many avoidable adult and child deaths in coming years in Brazil.
预测巴西家庭健康战略（Estratégia Saúde da Família，ESF）覆盖范围变化的替代情景（由于财政紧缩措施以及“更多医生”计划（Programa Mais Médicos，PMM）结束）对截至2030年5岁以下儿童总体死亡率（U5MR）和70岁以下人群死亡率（U70MR）中门诊护理敏感疾病（ACSC）的影响。
为2017 - 2030年期间创建了一个由5507个巴西市镇组成的合成队列。使用纵向数据开发并验证了一个市级微观模拟模型。与维持当前ESF覆盖范围相比，基于两种可能的紧缩情景预测了ESF覆盖范围的减少及其对ACSC的U5MR和U70MR的影响。采用固定效应纵向回归模型来考虑长期趋势、人口和社会经济变化、与医疗保健相关的变量以及项目持续时间的影响。
与维持稳定的ESF覆盖范围相比，由于紧缩措施和PMM终止导致ESF覆盖范围下降，到2030年，平均U5MR和U70MR将分别高出13.2%和8.6%。PMM的结束将导致2030年ACSC的平均U5MR高出4.3%，ACSC的U70MR高出2.8%。仅因退出在PMM工作的古巴医生而导致的PMM覆盖范围减少，将使2030年的U5MR高出3.2%，U70MR高出2.0%。
由于紧缩措施和PMM的结束导致的初级卫生保健覆盖范围的减少，可能会在未来几年导致巴西许多可避免的成人和儿童死亡。
