More doctors, better health? A generalised synthetic control approach to estimating impacts of increasing doctors under Brazil's Mais Medicos programme
File(s)
Published version
Author(s)
Thomas, Rhys Llewellyn
Millett, Christopher
Soares, Ricardo de Sousa
Hone, Thomas
Type
Journal Article
Abstract
Worldwide, there are an insufficient number of primary care physicians to provide accessible, high-quality primary care services. Better knowledge on the health impacts of policies aimed at improving access to primary care physicians is important for informing future policies.
Using a generalised synthetic control estimator (GSC), we estimate the effect of the increase in primary care physicians from the Programa Mais Médicos in Brazil. The GSC allows us to estimates a continuous treatment effects which are heterogenous by region. We exploit the variation in physicians allocated to each Brazilian microregion to identify the impact of an increasing Mais Médicos primary care physicians. We explore hospitalisations and mortality rates (both total and from ambulatory care sensitive conditions) as outcomes. Our analysis differs from previous work by estimating the impact of the increase in physician numbers, as opposed to the overall impact of programme participation. We examine the impact on hospitalisations and mortality rates and employ a panel dataset with monthly observations of all Brazilian microregion over the period 2008–2017.
We find limited effects of an increase in primary care physicians impacting health outcomes - with no significant impact of the Programa Mais Médicos on hospitalisations or mortality rates. Potential explanations include substitution of other health professionals, impacts materialising over the longer-term, and poor within-region allocation of Mais Médicos physicians.
Using a generalised synthetic control estimator (GSC), we estimate the effect of the increase in primary care physicians from the Programa Mais Médicos in Brazil. The GSC allows us to estimates a continuous treatment effects which are heterogenous by region. We exploit the variation in physicians allocated to each Brazilian microregion to identify the impact of an increasing Mais Médicos primary care physicians. We explore hospitalisations and mortality rates (both total and from ambulatory care sensitive conditions) as outcomes. Our analysis differs from previous work by estimating the impact of the increase in physician numbers, as opposed to the overall impact of programme participation. We examine the impact on hospitalisations and mortality rates and employ a panel dataset with monthly observations of all Brazilian microregion over the period 2008–2017.
We find limited effects of an increase in primary care physicians impacting health outcomes - with no significant impact of the Programa Mais Médicos on hospitalisations or mortality rates. Potential explanations include substitution of other health professionals, impacts materialising over the longer-term, and poor within-region allocation of Mais Médicos physicians.
Date Issued
2024-10-01
Date Acceptance
2024-08-09
Citation
Social Science and Medicine, 2024, 358
ISSN
0277-9536
Publisher
Elsevier
Journal / Book Title
Social Science and Medicine
Volume
358
Copyright Statement
© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/39181082
PII: S0277-9536(24)00675-0
Subjects
Biomedical Social Sciences
Brazil
COVERAGE
Doctors
Hospitalisations
HOSPITALIZATIONS
Human resources for health
HUMAN-RESOURCES
Life Sciences & Biomedicine
Mortality
PHYSICIANS
Primary care
PRIMARY-CARE
Public, Environmental & Occupational Health
RURAL-AREAS
Science & Technology
Social Sciences
Social Sciences, Biomedical
Synthetic control
Publication Status
Published
Coverage Spatial
England
Article Number
117222
Date Publish Online
2024-08-17