The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas |
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| Affiliation: | 1. Fipe- Foundation Institute for Economic Research, Brazil;2. Economics Department, University of São Paulo, Brazil;3. Economics Department, Insper - Institute of Education and Research, Brazil;4. Centre for Health Economics, University of York, UK;1. LEO, University of Tours, France;2. CEPII, France;3. Paris School of Economics and CNRS, 48 Boulevard Jourdan, 75014 Paris, France;4. Paris School of Economics, ENPC-Paris Tech, PUC-Rio, France;1. Australia India Institute, University of Western Australia, Australia;2. Bankwest Curtin Economics Centre, Curtin University, Australia;3. UWA Business School, University of Western Australia, Australia;4. Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Mumbai, India;1. Département de sciences économiques, Université du Québec á Montréal, 315 Rue Sainte-Catherine E, Montréal H2X 3X2, Québec, Canada;1. Institute for Employment Research (IAB), Regensburger Strasse 104, 90478 Nuremberg, Germany;2. Federal Institute for Occupational Safety and Health, Friedrich-Henkel-Weg 1-25, 44149 Dortmund, Germany;1. EconomiX-CNRS, University of Paris Nanterre, 200 Avenue de la République, 92001 Nanterre Cedex, France;2. Department of Political Sciences, University of Perugia, via Pascoli, 20, Perugia, Italy;3. Institute of Labor Economics (IZA), Germany |
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| Abstract: | Previous studies have found that the expansion of primary health care in Brazil following the country-wide family health strategy (ESF), one of the largest primary care programs in the world, has improved health outcomes. However, these studies have relied either on aggregate data or on limited individual data, with no fine-grained information available concerning household participation in the ESF or local supply of ESF services, which represent crucial aspects for analytical and policy purposes. This study analyzes the relationship between the ESF and health outcomes for the adult population in metropolitan areas in Brazil. We investigate this relationship through two linked dimensions of the ESF: the program’s local supply of health teams and ESF household registration. In contrast with previous studies focusing on comparisons between certain definitions of "treated" versus "nontreated" populations, our results indicate that the local density of health teams is important to the observed effects of the ESF on adult health. We also find evidence consistent with the presence of positive primary health care spillovers to people not registered with the ESF. However, current ESF coverage levels in metropolitan areas have limited ability to address prevailing health inequalities. Our analysis suggests that the local intensity of ESF coverage should be a key consideration for evaluations and policy efforts related to future ESF expansion. |
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| Keywords: | Family health strategy Self-assessed health Fixed effects Pooled cross-section Health surveys |
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