Indicadores municipais da Atenção Primária à Saúde no Brasil: desempenho e oferta no período 2020-2022

Abstract

Primary Health Care (PHC) is the basis of modern health systems and a strengthened PHC is associated with better health outcomes and reduced costs without negative impacts on the quality of care. In Brazil, the Family Health Strategy (FHS) has been fundamental to the reorientation of the health care model based on PHC, expanding access to health services to lower income people, and contributing to the improvement of health indicators. From the funding point of view, the ESF has expanded through the incentives of the Piso da Atenção Básica (PAB) with its Fixed and Variable components. In 2019, the Previne Brazil Program was instituted, which represents a change in the financing of PHC in Brazil by replacing the Fixed PAB by Weighted Capitation and the Variable PAB by Payment for Performance and Incentive for Strategic Actions, and later being added a payment component by population criteria. This work proposes to analyze the evolution of the Previne Brazil Program monitoring indicators by groups of municipalities classified according to a Composite PHC Index. This composite index defines homogeneous groups of municipalities according to the performance of PHC and the structure of health services supply at the time of the institution of the new program. In this way, it was possible to evaluate the evolution of enrollment and performance indicators monitored by Previne Brasil among municipalities with common characteristics. The results found in the construction of the typology of municipalities show that there is a strong regional inequality in the performance of PHC and health supply in Brazil, with the best results observed in the South and Southeast regions and the most precarious situation in the North of the country. The results of the evolution of Previne Brazil's monitoring indicators indicate an improvement in performance and expansion of the general registry in municipalities with distinct characteristics, but still insufficient to guarantee the maximum transfer in all municipalities, especially in those with low performance and low supply before the new financing model. It is also noteworthy the uneven performance between groups of different characteristics for specific indicators, suggesting that there is room for improvement and the need to implement instruments that consider the different realities of the country. Previne Brazil is still a recent program and provides a significant change in the financing of PHC, therefore, further analyses that evaluate the impact of the program on health indicators and different strata of the population according to sex, age, color or race, and social class are fundamental.