ArticleBMJ global health2021
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.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Affordability of new drugs in the Brazilian public health system: a 13-year monitoring analysis of reimbursement decisions based on health technology assessments (2012-2024).Lancet regional health. Americas · 2026Article
- Prospective payment system transformation (2000-2024): temporal trends, payment architecture, and cross-national variation.Health economics review · 2026Review
- Behavioral responses of healthcare providers to prospective payment systems: a systematic review using the WHO framework (2000-2024).Health economics review · 2026Review
- Quality indicators for improved cardiovascular care: learnings from the National Institute for Health and Care Excellence.European heart journal. Quality of care & clinical outcomes · 2025Article
- Does pay-for-performance design matter? Evidence from Brazil.Health policy and planning · 2024Article
- Inclusion of disability in primary healthcare facilities and socioeconomic inequity in Brazil.Revista de saude publica · 2024Article
- Characteristics of house calls in Brazil: analysis of PMAQ-AB external evaluation cycles.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2024Article
- Spatiotemporal analysis of diarrhea-related hospitalizations of children in Brazil's Midwest region from 2011 to 2020.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2024Article
- Association between hospitalizations for sensitive conditions and quality of primary care.Revista de saude publica · 2023Article
- Effectiveness of Agreement Criteria and Flows of Collaborative Care in Primary Mental Health Care in Brazil.International journal of environmental research and public health · 2022Article
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13 authors.
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Abstract
backgroundEvidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities.
methodsWe conducted a fixed effect panel data analysis over the period of 2009-2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs.
resultsThe results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0-64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (-0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected.
conclusionWe find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
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