@article{Rasella:2019:10.1186/s12916-019-1316-7,
author = {Rasella, D and Hone, T and de, Souza LE and Tasca, R and Basu, S and Millett, C},
doi = {10.1186/s12916-019-1316-7},
journal = {BMC Medicine},
title = {Mortality associated with alternative primary health care policies: a nationwide microsimulation modelling study in Brazil},
url = {http://dx.doi.org/10.1186/s12916-019-1316-7},
volume = {17},
year = {2019}
}

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TY  - JOUR
AB  - BackgroundBrazil’s Estratégia Saúde da Família (ESF) is one of the largest and most robustly evaluated primary healthcare programmes of the world, but it could be affected by fiscal austerity measures and by the possible end of the Mais Médicos programme (MMP)—a major intervention to increase primary care doctors in underserved areas. We forecast the impact of alternative scenarios of ESF coverage changes on under-70 mortality from ambulatory care-sensitive conditions (ACSCs) until 2030, the date for achievement of the Sustainable Development Goals (SDGs).MethodA synthetic cohort of 5507 Brazilian municipalities was created for the period 2017–2030. A municipal-level microsimulation model was developed and validated using longitudinal data and estimates from a previous retrospective study evaluating the effects of municipal ESF coverage on mortality rates. Reductions in ESF coverage, and its effects on ACSC mortality, were forecast based on two probable austerity scenarios, compared with the maintenance of the current coverage or the expansion to 100%. Fixed effects longitudinal regression models were employed to account for secular trends, demographic and socioeconomic changes, healthcare-related variables, and programme duration effects.ResultsUnder austerity scenarios of decreasing ESF coverage with and without the MMP termination, mean ACSC mortality rates would be 8.60% (95% CI 7.03–10.21%; 48,546 excess premature/under-70 deaths along 2017–2030) and 5.80% (95% CI 4.23–7.35%; 27,685 excess premature deaths) higher respectively in 2030 compared to maintaining the current ESF coverage.Comparing decreasing ESF coverage and MMP termination with achieving 100% ESF coverage (Universal Health Coverage scenario) in 2030, mortality rates would be 11.12% higher (95% CI 9.47–12.76%; 83,937 premature deaths). Reductions in ESF coverage would have stronger effects on mortality from infectious diseases and
AU  - Rasella,D
AU  - Hone,T
AU  - de,Souza LE
AU  - Tasca,R
AU  - Basu,S
AU  - Millett,C
DO  - 10.1186/s12916-019-1316-7
PY  - 2019///
SN  - 1741-7015
TI  - Mortality associated with alternative primary health care policies: a nationwide microsimulation modelling study in Brazil
T2  - BMC Medicine
UR  - http://dx.doi.org/10.1186/s12916-019-1316-7
UR  - http://hdl.handle.net/10044/1/69758
VL  - 17
ER  - 

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