Major Expansion Of Primary Care In Brazil Linked To Decline In Unnecessary Hospitalization

Bibliographic Data

ID23345819
AuthorsJames Macinko (0000-0001-8055-5441, James Macinko ( ) is an associate professor of public health and health policy at New York University, in New York City.), Ines Dourado (0000-0003-1675-2146, Inês Dourado is an associate professor at the Public Health Institute, Federal University of Bahia, in Brazil.), Redford Aquino (0000-0003-3906-5170, Rosana Aquino is an associate researcher at the Public Health Institute, Federal University of Bahia.), Rosana Aquino (Rosana Aquino is an associate researcher at the Public Health Institute, Federal University of Bahia.), Palmira De Fátima Bonolo (0000-0003-2744-7139, Palmira de Fátima Bonolo is an associate professor of medicine at the Federal University of Ouro Preto, in Brazil.), Maria Fernanda Furtado Lima-Costa (0000-0002-3474-2980, Fundação Oswaldo Cruz), Maria Fernanda Lima-Costa (0000-0002-1077-1381, Maria Fernanda Lima-Costa is a professor of epidemiology at the Oswaldo Cruz Foundation’s René Rachou Research Institute, in Belo Horizonte, Brazil.), Maria Guadalupe Medina (0000-0001-7283-2947, Maria Guadalupe Medina is an associate researcher at the Public Health Institute, Federal University of Bahia.), Eduardo Luiz Andrade Mota (0000-0001-7819-0084, Eduardo Mota is an associate professor and director of the Public Health Institute, Federal University of Bahia.), Eduardo Mota (Eduardo Mota is an associate professor and director of the Public Health Institute, Federal University of Bahia.), Veneza Berenice De Oliveira (0000-0002-1247-2465, Veneza Berenice de Oliveira is an associate professor at the Medical School, Federal University of Minas Gerais, in Brazil.), Maria Aparecida Turci (0000-0002-4380-4231, Maria Aparecida Turci is a researcher at the Center for Public Health Education (NESCON), Federal University of Minas Gerais.)
Year2010
Volume29
Issue12
Pages2149-2160
Publication date2010-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueHealth Affairs (JOURNAL)
Journal identifiersISSN: 0278-2715 • E-ISSN: 2694-233X
PublisherHealth Affairs Publishing, LLC (PUBLISHER)
DOI10.1377/hlthaff.2010.0251
PMID21134915
OpenAlexW2116639139
LanguageEN
Citations received77
References cited23

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.

Environmental health · Family medicine · Population · Primary care · Primary health care · Healthcare cost, quality, practices · Healthcare Policy and Management · Medicine · Primary Care and Health Outcomes · Gerontology