Antiga Maria Luisa de Oliveira Collino, Freitas Bruna Leão, Brizan-St Martin Roxanne, La Foucade Althea, Sarti Flavia Mori
School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil.
Faculty of Social Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
Healthcare (Basel). 2025 Apr 9;13(8):857. doi: 10.3390/healthcare13080857.
: Primary healthcare (PHC) plays a central role in the promotion of universal healthcare coverage within the Brazilian health system. Nevertheless, inequalities across municipalities represent substantial barriers to achieving equity in access to health, particularly due to disparities in the quality of healthcare delivered to patients. Thus, the study aimed to investigate factors associated with perception of PHC quality among adult individuals using private and public facilities within the Brazilian health system. : The empirical approach was based on quantitative analysis of cross-sectional data from five nationally representative surveys conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) in 1998, 2003, 2008, 2013, and 2019. Pairwise comparisons and marginal analyses allowed for the assessment of differences in patients' perception of healthcare quality according to source of funding and type of healthcare quality. A logistic regression model was estimated to identify factors associated with the perception of good quality of care. Model discrimination, calibration, and goodness-of-fit were assessed to ensure the robustness of analyses. : The results indicate that patients' satisfaction was positively associated with level of implementation of the national program based on payment for performance in public healthcare facilities, PMAQ-AB (OR = 3.376; < 0.001), self-assessment of good health status (OR = 3.209; < 0.001), and healthcare financed through health insurance (OR = 2.344; < 0.001). Contrarily, receiving healthcare in a public facility (OR = 0.358; < 0.001) was negatively associated with the evaluation of good quality. : The findings showed that patients' perception of quality of care presents significant associations with patients' health characteristics, healthcare funding source, and implementation of the PMAQ-AB. Furthermore, patients generally perceived lower healthcare quality in public facilities. The study indicates the need for evidence-based decision-making in public policies of health, particularly regarding further advances in payment for performance programs designed to foster improvements in quality of care within public PHC facilities in Brazil.
初级卫生保健（PHC）在巴西卫生系统促进全民医保覆盖方面发挥着核心作用。然而，各市之间的不平等是实现卫生服务公平可及的重大障碍，尤其是因为提供给患者的医疗服务质量存在差异。因此，本研究旨在调查巴西卫生系统中使用私立和公立医疗机构的成年个体对初级卫生保健质量认知的相关因素。
实证方法基于对巴西地理与统计研究所（Instituto Brasileiro de Geografia e Estatística，IBGE）在1998年、2003年、2008年、2013年和2019年进行的五项全国代表性调查的横断面数据进行定量分析。成对比较和边际分析有助于根据资金来源和医疗质量类型评估患者对医疗服务质量认知的差异。估计了一个逻辑回归模型，以确定与优质护理认知相关的因素。评估了模型的区分度、校准度和拟合优度，以确保分析的稳健性。
结果表明，患者满意度与基于公共医疗机构绩效付费的国家项目PMAQ-AB的实施水平呈正相关（OR = 3.376；P < 0.001）、自我评估健康状况良好（OR = 3.209；P < 0.001）以及通过健康保险资助的医疗服务（OR = 2.344；P < 0.001）。相反，在公立机构接受医疗服务（OR = 0.358；P < 0.001）与优质评价呈负相关。
研究结果表明，患者对医疗服务质量的认知与患者的健康特征、医疗资金来源以及PMAQ-AB的实施存在显著关联。此外，患者普遍认为公立机构的医疗服务质量较低。该研究表明，在卫生公共政策中需要基于证据进行决策，特别是在旨在促进巴西公立初级卫生保健机构护理质量提升的绩效付费项目的进一步推进方面。
