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The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas

Author

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  • Ferreira-Batista, Natalia N.
  • Postali, Fernando Antonio Slaibe
  • Diaz, Maria Dolores Montoya
  • Teixeira, Adriano Dutra
  • Moreno-Serra, Rodrigo

Abstract

Previous studies have found that the expansion of primary health care in Brazil following the country-wide family health strategy (ESF), one of the largest primary care programs in the world, has improved health outcomes. However, these studies have relied either on aggregate data or on limited individual data, with no fine-grained information available concerning household participation in the ESF or local supply of ESF services, which represent crucial aspects for analytical and policy purposes. This study analyzes the relationship between the ESF and health outcomes for the adult population in metropolitan areas in Brazil. We investigate this relationship through two linked dimensions of the ESF: the program’s local supply of health teams and ESF household registration. In contrast with previous studies focusing on comparisons between certain definitions of "treated" versus "nontreated" populations, our results indicate that the local density of health teams is important to the observed effects of the ESF on adult health. We also find evidence consistent with the presence of positive primary health care spillovers to people not registered with the ESF. However, current ESF coverage levels in metropolitan areas have limited ability to address prevailing health inequalities. Our analysis suggests that the local intensity of ESF coverage should be a key consideration for evaluations and policy efforts related to future ESF expansion.

Suggested Citation

  • 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).
    • Handle: RePEc:eee:ehbiol:v:46:y:2022:i:c:s1570677x22000399
    DOI: 10.1016/j.ehb.2022.101143
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    1. van Doorslaer, Eddy & Gerdtham, Ulf-G., 2003. "Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data," Social Science & Medicine, Elsevier, vol. 57(9), pages 1621-1629, November.
    2. Benjamin-Chung, Jade & Abedin, Jaynal & Berger, David & Clark, Ashley & Jimenez, Veronica & Konagaya, Eugene & Tran, Diana & Arnold, Benjamin F & Hubbard, Alan E & Luby, Stephen P & Miguel, Edward & C, 2017. "Spillover effects on health outcomes in low- and middle-income countries: a systematic review," Department of Economics, Working Paper Series qt15f554dd, Department of Economics, Institute for Business and Economic Research, UC Berkeley.
    3. Moreno-Serra R, "undated". "Health Programme Evaluation by Propensity Score Matching: Accounting for Treatment Intensity and Health Externalities with an Application to Brazil," Health, Econometrics and Data Group (HEDG) Working Papers 09/05, HEDG, c/o Department of Economics, University of York.
    4. Natalia Guerrero & Oswaldo Molina & Diego Winkelried, 2020. "Conditional cash transfers, spillovers, and informal health care: Evidence from Peru," Health Economics, John Wiley & Sons, Ltd., vol. 29(2), pages 111-122, February.
    5. Thomas Hone & Davide Rasella & Mauricio L Barreto & Azeem Majeed & Christopher Millett, 2017. "Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis," PLOS Medicine, Public Library of Science, vol. 14(5), pages 1-19, May.
    6. Ciro Avitabile, 2012. "Does Information Improve the Health Behavior of Adults Targeted by a Conditional Transfer Program?," Journal of Human Resources, University of Wisconsin Press, vol. 47(3), pages 785-825.
    7. Michele Gragnolati & Magnus Lindelow & Bernard Couttolenc, 2013. "Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde," World Bank Publications - Books, The World Bank Group, number 15801.
    8. Reis, Mauricio, 2012. "Differences in nutritional outcomes between Brazilian white and black children," Economics & Human Biology, Elsevier, vol. 10(2), pages 174-188.
    9. Sonia Bhalotra & Rudi Rocha & Rodrigo R. Soares, 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," Documentos de Trabajo 17122, The Latin American and Caribbean Economic Association (LACEA).
    10. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    11. Guanais, F.C., 2015. "The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010," American Journal of Public Health, American Public Health Association, vol. 105, pages 593-9,585-9.
    12. Macinko, James & de Fátima Marinho de Souza, Maria & Guanais, Frederico C. & da Silva Simões, Celso Cardoso, 2007. "Going to scale with community-based primary care: An analysis of the family health program and infant mortality in Brazil, 1999-2004," Social Science & Medicine, Elsevier, vol. 65(10), pages 2070-2080, November.
    13. Mossey, J.M. & Shapiro, E., 1982. "Self-rated health: a predictor of mortality among the elderly," American Journal of Public Health, American Public Health Association, vol. 72(8), pages 800-808.
    14. Aquino, R. & De Oliveira, N.F. & Barreto, M.L., 2009. "Impact of the Family Health Program on infant mortality in brazilian municipalities," American Journal of Public Health, American Public Health Association, vol. 99(1), pages 87-93.
    15. 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.
    16. William H. Greene & Mark N. Harris & Bruce Hollingsworth, 2015. "Inflated Responses in Measures of Self-Assessed Health," American Journal of Health Economics, MIT Press, vol. 1(4), pages 461-493, Fall.
    17. Mayara Lisboa Bastos & Dick Menzies & Thomas Hone & Kianoush Dehghani & Anete Trajman, 2017. "The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-14, August.
    18. Gerdtham, U. -G. & Johannesson, M. & Lundberg, L. & Isacson, D., 1999. "A note on validating Wagstaff and van Doorslaer's health measure in the analysis of inequalities in health," Journal of Health Economics, Elsevier, vol. 18(1), pages 117-124, January.
    19. Crossley, Thomas F. & Kennedy, Steven, 2002. "The reliability of self-assessed health status," Journal of Health Economics, Elsevier, vol. 21(4), pages 643-658, July.
    20. Thomas Hone & Valeria Saraceni & Claudia Medina Coeli & Anete Trajman & Davide Rasella & Christopher Millett & Betina Durovni, 2020. "Primary healthcare expansion and mortality in Brazil’s urban poor: A cohort analysis of 1.2 million adults," PLOS Medicine, Public Library of Science, vol. 17(10), pages 1-20, October.
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    1. 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.

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    More about this item

    Keywords

    Family health strategy; Self-assessed health; Fixed effects; Pooled cross-section; Health surveys;
    All these keywords.

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C23 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Models with Panel Data; Spatio-temporal Models

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