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How the ‘plates’ of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

Author

Listed:
  • Giuliano Russo
  • Maria Luiza Levi
  • Maria Teresa Seabra Soares de Britto e Alves
  • Bruno Luciano Carneiro Alves de Oliveira
  • Ruth Helena de Souza Britto Ferreira de Carvalho
  • Lucas Salvador Andrietta
  • Jonathan Gonçalves Filippon
  • Mário César Scheffer

Abstract

Background: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. Methods: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. Results: We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible–if insecure–working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. Conclusions: The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

Suggested Citation

  • Giuliano Russo & Maria Luiza Levi & Maria Teresa Seabra Soares de Britto e Alves & Bruno Luciano Carneiro Alves de Oliveira & Ruth Helena de Souza Britto Ferreira de Carvalho & Lucas Salvador Andriett, 2020. "How the ‘plates’ of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão sta," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-20, October.
    • Handle: RePEc:plo:pone00:0241017
    DOI: 10.1371/journal.pone.0241017
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    References listed on IDEAS

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    1. 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, December.
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    1. Bruno Luciano Carneiro Alves de Oliveira & Lucas Salvador Andrietta & Regimarina Soares Reis & Ruth Helena de Souza Britto Ferreira de Carvalho & Maria Teresa Seabra Soares de Britto e Alves & Mário C, 2022. "The Impact of the COVID-19 Pandemic on Physicians’ Working Hours and Earnings in São Paulo and Maranhão States, Brazil," IJERPH, MDPI, vol. 19(16), pages 1-13, August.

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