Major expansion of primary care in Brazil linked to decline in unnecessary hospitalization.
In 1994 Brazil launched what has since become the world's largest community-based primary health care program. Under the Family Health Program, teams consisting of at least one physician, one nurse, a medical assistant, and four to six trained community health agents deliver most of their services at community-based clinics. They also make regular home visits and conduct neighborhood health promotion activities. This study finds that during 1999-2007, hospitalizations in Brazil for ambulatory care-sensitive chronic diseases, including cardiovascular disease, stroke, and asthma, fell at a rate that was statistically significant and almost twice the rate of decline in hospitalizations for all other causes. In municipalities with high Family Health Program enrollment, chronic disease hospitalization rates were 13 percent lower than in municipalities with low enrollment, when other factors were held constant. These results suggest that the Family Health Program has improved health system performance in Brazil by reducing the number of potentially avoidable hospitalizations.
Public Health and Health Policy, New York University, New York City, USA. james.macinko@nyu.edu
James
J
Macinko
Inês
I
Dourado
Rosana
R
Aquino
Palmira de Fátima
Pde F
Bonolo
Maria Fernanda
MF
Lima-Costa
Maria Guadalupe
MG
Medina
Eduardo
E
Mota
Veneza Berenice
VB
de Oliveira
Maria Aparecida
MA
Turci
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000600:supply & distribution; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D055815:Young Adult