Health Sciences Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil.
Department of Health Promotion, Federal University of Paraíba, Campus I, Jardim Universitário, S/N, Castelo Branco, João Pessoa, PB, Brazil.
Hum Resour Health. 2021 Mar 16;19(1):33. doi: 10.1186/s12960-021-00580-5.
Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians' distribution.
This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare.
From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013-2015 period. Increase in physician supply improved access to antenatal care.
There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.
医生短缺和分布不均是实现全民健康覆盖的障碍，尤其是在中低收入国家。在巴西，扩大医学院招生规模、课程改革和招聘计划已经建立，以增加服务不足地区的医生数量。本研究旨在分析这些措施对减少获得医学教育和医生分布方面的不平等的影响。
这是一项观察性研究，分析了 2010 年至 2018 年期间巴西不同地区本科医学专业招生人数和每居民医生人数的变化。本科医学专业招生人数、医生人数和执业地点的数据从公共数据库中获得。居民少于 2 万人的城市被视为服务不足地区。产前检查的获得情况被作为获得医疗保健影响的替代指标进行分析。
从 2010 年到 2018 年，共增加了 19519 个新的本科医学专业招生名额，增加了 120.2%。在此期间，从事医疗工作的医生人数增加了 113702 人，其中 74771 人在统一卫生系统工作。在人口最少、人均国内生产总值最低的城市以及医生分布最集中的州，医生与每 1000 名居民的比例在 2013-2015 年期间增长最大。医生供应量的增加改善了产前保健的可及性。
在巴西评估的所有城市群体中，本科医学专业招生人数和医疗人员数量都有所增加。联邦公立学校本科医学专业招生人数的扩大比私营部门更有效地减少了获得医学教育方面的地区不平等。“为巴西增加更多医生”计划的招聘部分在增加服务不足地区医生数量方面显示出了有效性。我们的研究结果表明，需要实施公共政策来解决获得医学教育和医生短缺方面的不平等问题，并在实施期间进行持续评估，尤其是在政治和经济变化的背景下。
