ArticleBMC health services research2020
Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities.
Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 66 citations in OpenAlex.
- What happens to population health when the doctors leave? Evidence from the exit of Cuban doctors in Brazil.Journal of health economics · 2026Article
- Academic partnerships for family medicine and primary health care education: a global narrative review 7 years after Astana.Frontiers in medicine · 2026Review
- Thirty years of the Family Health Strategy in the Brazilian Unified National Health System: milestones, advances, setbacks and challenges.Cadernos de saude publica · 2026Article
- Infrastructure-health nexus in Brazil: a scoping review.Global health research and policy · 2025Article
- Trends and Geographical Distribution of Family Health Strategy in Brazil from 2009-2023.Healthcare (Basel, Switzerland) · 2025Article
- Brazil's experiment to expand its medical workforce through private and public schools: Impacts and consequences of the balance of regulatory and market forces in resource-scarce settings.Globalization and health · 2025Article
- Time series analysis of comprehensive maternal deaths in Brazil during the COVID-19 pandemic.Scientific reports · 2024Article
- More doctors, better health? A generalised synthetic control approach to estimating impacts of increasing doctors under Brazil's Mais Medicos programme.Social science & medicine (1982) · 2024Article
- Trend and spatial clustering of medical education in Brazil: an ecological study of time series from 2010 to 2021.BMC health services research · 2023Article
- Association between inequalities in human resources for health and all cause and cause specific mortality in 172 countries and territories, 1990-2019: observational study.BMJ (Clinical research ed.) · 2023Observational
- Effects of individual and organizational factors on job tenure of primary care physicians: A multilevel analysis from Brazil.PloS one · 2023Observational
- Evaluation of primary health care by users during the COVID-19 pandemic: A cross-sectional study.PloS one · 2023Article
- Challenges to the provision of specialized care in remote rural municipalities in Brazil.BMC health services research · 2022Article
- Article
- Virtual Learning Environment of the Brazilian Health System (AVASUS): Efficiency of Results, Impacts, and Contributions.Frontiers in medicine · 2022Article
- Primary care experiences among Brazilian adults: Cross-sectional evidence from the 2019 National Health Survey.PloS one · 2022Article
- Incorporating Medical Supply and Demand into the Index of Physician Maldistribution Improves the Sensitivity to Healthcare Outcomes.Journal of clinical medicine · 2021Article
- Brazil's more doctors programme and infant health outcomes: a longitudinal analysis.Human resources for health · 2021Article
- Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018.BMJ global health · 2021Article
- Assessing the performance of beneficiary targeting in Brazil's More Doctors Programme.Health policy and planning · 2021Article
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Authors and funding
9 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundInvesting in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality.
methodsDifference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008-2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction.
resultsAfter starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of - 1.06 per 100,000 (95%CI: - 1.78 to - 0.34) annually - with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation.
conclusionsPMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.
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