Programa Previne Brasil: análise da mudança do modelo de financiamento federal da Atenção Primária à Saúde em municípios do estado de Minas Gerais

Abstract

Specific funding for Primary Health Care (PHC) was established in 1996, through the creation of the Basic Care (PAB), composed of a fixed part (Fixed PAB) and another variable (Variable PAB). In 2019, the Ministry of Health defined a new financing model for PHC, called Programa Previne Brasil, composed of Weighted Capitation, Payment for Performance and Incentive for Strategic Actions. The general objective of this study was to analyze the changes caused in indicators and in the financing of Primary Care in the municipalities of the state of Minas Gerais through the institution of the Previne Brasil Program. This is a descriptive cross-sectional research, with a quantitative approach, carried out from secondary data, contained in public reports from the e-Gestor Primary Care portal and from the Brazilian Institute of Geography and Statistics (IBGE). The work was carried out for the 853 municipalities of Minas Gerais, with analysis disaggregated by health macro-regions. The period of analysis comprised the years 2018 to 2021, with the results of the 3rd quarter of each year. Descriptive statistical analysis was performed through the distribution of absolute and relative frequencies and arithmetic mean, with information organized in graphs, maps and tables. The analysis was performed according to observed results and results obtained from simulations, considering these groups: Weighted Capitation; Pay for Performance; Incentive for Strategic Actions; and Financing (Fixed PAB x Weighted Capital, PMAQ-AB x Pay for Performance, Variable PAB x Incentive for Strategic Actions, and Global Financing). The results found showed a significant increase in the registration of the population of the health macro-regions of Minas Gerais, including the vulnerable population, and a gradual improvement in the Pay for Performance indicators, despite all indicators presenting results far below the goals established by the Program. The replacement of the Variable PAB by the Incentive for Strategic Actions showed that some important teams were no longer funded by the federal government, some actions, programs and strategies were maintained and others were incorporated. The Weighted Capitation proved to be financially better than the Fixed PAB, however the Performance Pay and the Incentive for Strategic Actions were worse in relation to the PMAQ-AB and the Variable PAB, respectively. However, the analysis of global funding showed that the Programa Previne Brasil was financially better than the PAB for most municipalities in Minas Gerais. A technical report was prepared with the results found and suggestions for improvement for the advancement of the Previne Brasil Program. The analysis carried out in this work does not allow an impact assessment of the Previne Brasil Program, but an assessment of the process that generates knowledge and can contribute to its improvement and consolidation. This study may support further research on the new PHC financing model.