Evidence map›Paper›PMID 33104705›Full record

ArticlePloS one2020

How the 'plates' of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil's São Paulo and Maranhão states.

Giuliano Russo, Maria Luiza Levi, Maria Teresa Seabra Soares de Britto E Alves, Bruno Luciano Carneiro Alves de Oliveira, Ruth Helena de Souza Britto Ferreira de Carvalho, Lucas Salvador Andrietta, Jonathan Gonçalves Filippon, Mário César Scheffer

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Giuliano RussoCentre for Global Public Health, Institute for Population Health Studies, Queen Mary University of London, London, United Kingdom.ORCID 0000-0002-2716-369X
Maria Luiza LeviCenter for Engineering, Modelling and Applied Social Sciences, Federal University of ABC, Santo André, São Paulo, Brazil.
Maria Teresa Seabra Soares de Britto E AlvesDepartment of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Bruno Luciano Carneiro Alves de OliveiraDepartment of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Ruth Helena de Souza Britto Ferreira de CarvalhoDepartment of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Lucas Salvador AndriettaDepartment of Preventive Medicine, Faculty of de Medicine, University of São Paulo, São Paulo, Brazil.ORCID 0000-0001-5848-611X
Jonathan Gonçalves FilipponCentre for Global Public Health, Institute for Population Health Studies, Queen Mary University of London, London, United Kingdom.ORCID 0000-0003-3907-1992
Mário César SchefferDepartment of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil.

Funding

MEDICAL SCIENTIST TRAINING PROGRAMT32GM007205 · NIGMS · YALE UNIVERSITY · PI KAZMIERCZAK, BARBARA I · 1985 to 2019
$42.9M
Medical Research Council MR/R022747/1NIGMS NIH HHS T32 GM007205
6 · The paper itself

Abstract

backgroundEconomic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession.

methodsBetween 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.

resultsWe found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão.

conclusionsThe 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

Indexed as

BetacoronavirusCoronavirus InfectionsEconomic RecessionPandemicsPneumonia, ViralAdministrative PersonnelAmbulatory Care FacilitiesAttitude of Health PersonnelBrazilCommunity Health ServicesCOVID-19Developing CountriesHealth Care SectorHealth Facility AdministratorsHealth PersonnelHumans

Identifiers

PMID33104705
PMCPMC7588110

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.