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The influence of primary care and hospital supply on ambulatory care-sensitive hospitalizations among adults in Brazil, 1999-2007

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  • Macinko, J.
  • De Oliveira, V.B.
  • Turci, M.A.
  • Guanais, F.C.
  • Bonolo, P.F.
  • Lima-Costa, M.F.

Abstract

We assessed the influence of changes in primary care and hospital supply on rates of ambulatory care-sensitive (ACS) hospitalizations among adults in Brazil. Methods. We aggregated data on nearly 60 million public sector hospitalizations between 1999 and 2007 to Brazil's 558 microregions. We modeled adult ACS hospitalization rates as a function of area-level socioeconomic factors, health services supply, Family Health Program (FHP) availability, and health needs by using dynamic panel estimation techniques to control for endogenous explanatory variables. Results. The ACS hospitalization rates declined by more than 5% annually. When we controlled for other factors, FHP availability was associated with lower ACS hospitalization rates, whereas private or nonprofit hospital beds were associated with higher rates. Areas with highest predicted ACS hospitalization rates were those with the highest private or nonprofit hospital bed supply and with low ( 75%) FHP coverage and very few private or nonprofit hospital beds. Conclusions. These results highlight the contribution of the FHP to improved health system performance and reflect the complexity of the health reform processes under way in Brazil.

Suggested Citation

  • Macinko, J. & De Oliveira, V.B. & Turci, M.A. & Guanais, F.C. & Bonolo, P.F. & Lima-Costa, M.F., 2011. "The influence of primary care and hospital supply on ambulatory care-sensitive hospitalizations among adults in Brazil, 1999-2007," American Journal of Public Health, American Public Health Association, vol. 101(10), pages 1963-1970.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2010.198887_1
    DOI: 10.2105/AJPH.2010.198887
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    1. Ferreira-Batista, Natalia N. & Postali, Fernando Antonio Slaibe & Diaz, Maria Dolores Montoya & Teixeira, Adriano Dutra & Moreno-Serra, Rodrigo, 2022. "The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas," Economics & Human Biology, Elsevier, vol. 46(C).
    2. Natalia Nunes Ferreira‐Batista & Adriano Dutra Teixeira & Maria Dolores Montoya Diaz & Fernando Antonio Slaibe Postali & Rodrigo Moreno‐Serra & James Love‐Koh, 2023. "Is primary health care worth it in the long run? Evidence from Brazil," Health Economics, John Wiley & Sons, Ltd., vol. 32(7), pages 1504-1524, July.
    3. Lugo-Palacios, David G. & Cairns, John, 2015. "Using ambulatory care sensitive hospitalisations to analyse the effectiveness of primary care services in Mexico," Social Science & Medicine, Elsevier, vol. 144(C), pages 59-68.
    4. Letícia Xander Russo & Anthony Scott & Peter Sivey & Joilson Dias, 2019. "Primary care physicians and infant mortality: Evidence from Brazil," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-16, May.
    5. Denise de Fátima Barros Cavalcante & Valéria Silva Cândido Brizon & Livia Fernandes Probst & Marcelo de Castro Meneghim & Antonio Carlos Pereira & Gláucia Maria Bovi Ambrosano, 2018. "Did the Family Health Strategy have an impact on indicators of hospitalizations for stroke and heart failure? Longitudinal study in Brazil: 1998-2013," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-10, June.
    6. Channon, Andrew Amos & Andrade, Monica Viegas & Noronha, Kenya & Leone, Tiziana & Dilip, T.R., 2012. "Inpatient care of the elderly in Brazil and India: Assessing social inequalities," Social Science & Medicine, Elsevier, vol. 75(12), pages 2394-2402.
    7. Hessel, Philipp & Sayer, Pieter & Riumallo-Herl, Carlos, 2020. "Educational inequalities in disability linked to social security coverage among older individuals in five Latin American countries," Social Science & Medicine, Elsevier, vol. 267(C).
    8. Gusmano, Michael K. & Weisz, Daniel & Rodwin, Victor G. & Lang, Jonas & Qian, Meng & Bocquier, Aurelie & Moysan, Veronique & Verger, Pierre, 2014. "Disparities in access to health care in three French regions," Health Policy, Elsevier, vol. 114(1), pages 31-40.
    9. Vânia Cristina Campelo Barroso Carneiro & Paulo de Tarso Ribeiro de Oliveira & Saul Rassy Carneiro & Marinalva Cardoso Maciel & Janari da Silva Pedroso, 2021. "Evidence of the effect of primary care expansion on hospitalizations: Panel analysis of 143 municipalities in the Brazilian Amazon," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-14, April.

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