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Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil

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  • Sonia Bhalotra
  • Rudi Rocha
  • Rodrigo R. Soares

Abstract

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

Suggested Citation

  • 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 LACEA 017122, The Latin American and Caribbean Economic Association - LACEA.
  • Handle: RePEc:col:000518:017122
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    Cited by:

    1. Raphael Bruce & Alexsandros Cavgias, Luis Meloni, Mario Remigio, 2021. "Under Pressure: Women's Leadership During the COVID-19 Crisis," Working Papers, Department of Economics 2021_19, University of São Paulo (FEA-USP).
    2. Bhalotra, Sonia & Rocha, Rudi & Facchini, Gabriel & Menezes, Aline, 2019. "Productivity effects of dengue in Brazil," ISER Working Paper Series 2019-04, Institute for Social and Economic Research.
    3. Mateus Dias & Luiz Felipe Fontes, 2020. "The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil," Working Papers 09, Instituto de Estudos para Políticas de Saúde.
    4. Bhalotra, Sonia & Clarke, Damian & Gomes, Joseph F. & Venkataramani, Atheendar, 2021. "Maternal Mortality and Women’s Political Power," The Warwick Economics Research Paper Series (TWERPS) 1353, University of Warwick, Department of Economics.
    5. Bruce, Raphael & Cavgias, Alexsandros & Meloni, Luis & Remígio, Mário, 2022. "Under pressure: Women’s leadership during the COVID-19 crisis," Journal of Development Economics, Elsevier, vol. 154(C).
    6. Bhalotra, Sonia R. & Clarke, Damian & Gomes, Joseph & Venkataramani, Atheendar, 2018. "Maternal Mortality and Women's Political Participation," IZA Discussion Papers 11590, Institute of Labor Economics (IZA).
    7. Font-Gilabert, Paulino, 2020. "Taking cover: human capital accumulation in the presence of shocks and health insurance," ISER Working Paper Series 2020-16, Institute for Social and Economic Research.
    8. Bhalotra, Sonia R. & Nunes, Letícia & Rocha, Rudi, 2020. "Urgent Care Centers, Hospital Performance and Population Health," IZA Discussion Papers 13992, Institute of Labor Economics (IZA).
    9. Rudi Rocha & André Sant’Anna, 2020. "Winds of Fire and Smoke: Air Pollution and Health in the Brazilian Amazon," Working Papers 07, Instituto de Estudos para Políticas de Saúde.
    10. Christine Valente & Hans H. Sievertsen & Mahesh C. Puri, 2020. "Saving Neonatal Lives for a Quarter," Bristol Economics Discussion Papers 20/728, School of Economics, University of Bristol, UK.
    11. Ana I. Balsa & Patricia Triunfo, 2021. "The effects of expanded social health insurance on young mothers: Lessons from a pro‐choice reform in Uruguay," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 603-622, March.
    12. Dias, Mateus & Fontes, Luiz Felipe, 2020. "The Effects of a Large-Scale Mental-Health Reform: Evidence from Brazil," MPRA Paper 104753, University Library of Munich, Germany.
    13. Damian Clarke & Gustavo Cortés Méndez & Diego Vergara Sepúlveda, 2020. "Growing together: assessing equity and efficiency in a prenatal health program," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(3), pages 883-956, July.
    14. Gunes, Pinar Mine & Tsaneva, Magda, 2022. "The Effect of Brazil's Family Health Program on Cognitive Skills," IZA Discussion Papers 15784, Institute of Labor Economics (IZA).
    15. Rocha, Rudi & Sant’Anna, André Albuquerque, 2022. "Winds of fire and smoke: Air pollution and health in the Brazilian Amazon," World Development, Elsevier, vol. 151(C).
    16. Rudi Rocha & Isabela Furtado & Paula Spinola, 2020. "Financing Needs, Spending Projection and the Future of Health in Brazil," Working Papers 06, Instituto de Estudos para Políticas de Saúde.

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    More about this item

    Keywords

    Universal health coverage; health systems; primary care; maternal mortality; infantmortality; birth outcomes.;
    All these keywords.

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J10 - Labor and Demographic Economics - - Demographic Economics - - - General
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • J24 - Labor and Demographic Economics - - Demand and Supply of Labor - - - Human Capital; Skills; Occupational Choice; Labor Productivity
    • O54 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Latin America; Caribbean

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