Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis

Detalhes bibliográficos
Autor(a) principal: Fardousi, Nasser
Data de Publicação: 2022
Outros Autores: Silva, Everton Nunes da, Kovacs, Roxanne, Borghi, Josephine, Barreto, Jorge Otávio Maia, Kristensen, Søren Rud, Sampaio, Juliana, Shimizu, Helena Eri, Gomes, Luciano Bezerra, Russo, Letícia Xander, Gurgel, Garibaldi Dantas, Powell-Jackson, Timothy
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/59350
Resumo: This research was funded by the Medical Research Council, Newton Fund and the Brazilian National Council for the States Funding Agencies (CONFAP) under the UK to Brazil Joint Health Systems Research Call (grant MR/R022828/1). The MRC grant was awarded to JB and TPJ. Funding from CONFAP came from Fundac¸ão de Amparo à Pesquisa do Distrito Federal (FAPDF), Fundac¸ão de Amparo à Ciência e Tecnologia do Estado de Pernambuco (FACEPE) and Fundac¸ão de Apoio à Pesquisa do Estado da Paraı ´ba (FAPESQ). CONFAP funding was awarded to ES. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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spelling Fardousi, NasserSilva, Everton Nunes daKovacs, RoxanneBorghi, JosephineBarreto, Jorge Otávio MaiaKristensen, Søren RudSampaio, JulianaShimizu, Helena EriGomes, Luciano BezerraRusso, Letícia XanderGurgel, Garibaldi DantasPowell-Jackson, Timothy2023-07-02T23:38:02Z2023-07-02T23:38:02Z2022FARDOUSI, Nasser et al. Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis. Plos Medicine, [San Francisco], v. 19, n. 7, e1004033, jul. 2022.1549-1277PMC926224135797409https://www.arca.fiocruz.br/handle/icict/5935010.1371/journal.pmed.10040331549-1676This research was funded by the Medical Research Council, Newton Fund and the Brazilian National Council for the States Funding Agencies (CONFAP) under the UK to Brazil Joint Health Systems Research Call (grant MR/R022828/1). The MRC grant was awarded to JB and TPJ. Funding from CONFAP came from Fundac¸ão de Amparo à Pesquisa do Distrito Federal (FAPDF), Fundac¸ão de Amparo à Ciência e Tecnologia do Estado de Pernambuco (FACEPE) and Fundac¸ão de Apoio à Pesquisa do Estado da Paraı ´ba (FAPESQ). CONFAP funding was awarded to ES. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.London School of Hygiene & Tropical Medicine. Department of Global Health and Development. London, United Kingdom.University of Brasília. Brasília, DF, Brazil.London School of Hygiene & Tropical Medicine. Department of Global Health and Development. London, United Kingdom.London School of Hygiene & Tropical Medicine. Department of Global Health and Development. London, United Kingdom.Fundação Oswaldo Cruz. Fiocruz Brasília. Brasília, DF, Brasil.University of Southern Denmark. Centre for Health Economics. Odense, Denmark,Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil.University of Brasília. Brasília, DF, Brazil.Federal University of Paraiba. Department of Health Promotion. João Pessoa, PB, Brazil.Federal University of Grande Dourados. Dourados, MS, Brazil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Recife, PE, Brasil.London School of Hygiene & Tropical Medicine. Department of Global Health and Development. London, United Kingdom.Background: Pay-for-performance (P4P) programmes to incentivise health providers to improve quality of care have been widely implemented globally. Despite intuitive appeal, evidence on the effectiveness of P4P is mixed, potentially due to differences in how schemes are designed. We exploited municipality variation in the design features of Brazil’s National Programme for Improving Primary Care Access and Quality (PMAQ) to examine whether performance bonuses given to family health team workers were associated with changes in the quality of care and whether the size of bonus mattered. Methods and findings: For this quasi-experimental study, we used a difference-in-differences approach combined with matching. We compared changes over time in the quality of care delivered by family health teams between (bonus) municipalities that chose to use some or all of the PMAQ money to provide performance-related bonuses to team workers with (nonbonus) municipalities that invested the funds using traditional input-based budgets. The primary outcome was the PMAQ score, a quality of care index on a scale of 0 to 100, based on several hundred indicators (ranging from 598 to 660) of health care delivery. We did one-to-one matching of bonus municipalities to nonbonus municipalities based on baseline demographic and economic characteristics. On the matched sample, we used ordinary least squares regression to estimate the association of any bonus and size of bonus with the prepost change over time (between November 2011 and October 2015) in the PMAQ score. We performed subgroup analyses with respect to the local area income of the family health team. The matched analytical sample comprised 2,346 municipalities (1,173 nonbonus municipalities; 1,173 bonus municipalities), containing 10,275 family health teams that participated in PMAQ from the outset. Bonus municipalities were associated with a 4.6 (95% CI: 2.7 to 6.4; p < 0.001) percentage point increase in the PMAQ score compared with nonbonus municipalities. The association with quality of care increased with the size of bonus: the largest bonus group saw an improvement of 8.2 percentage points (95% CI: 6.2 to 10.2; p < 0.001) compared with the control. The subgroup analysis showed that the observed improvement in performance was most pronounced in the poorest two-fifths of localities. The limitations of the study include the potential for bias from unmeasured time-varying confounding and the fact that the PMAQ score has not been validated as a measure of quality of care. Conclusions: Performance bonuses to family health team workers compared with traditional input-based budgets were associated with an improvement in the quality of care.engPublic Library of ScienceReimbursement, IncentiveBrazilFamily HealthHumansPrimary Health CareQuality of Health CarePrimary health careFamily health teamsQuality of health careReimbursement, incentiveReembolso de IncentivoSaúde da FamíliaAtenção Primária à SaúdeQualidade da Assistência à SaúdePerformance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysisinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; 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dc.title.en_US.fl_str_mv Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
title Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
spellingShingle Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
Fardousi, Nasser
Reimbursement, Incentive
Brazil
Family Health
Humans
Primary Health Care
Quality of Health Care
Primary health care
Family health teams
Quality of health care
Reimbursement, incentive
Reembolso de Incentivo
Saúde da Família
Atenção Primária à Saúde
Qualidade da Assistência à Saúde
title_short Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
title_full Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
title_fullStr Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
title_full_unstemmed Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
title_sort Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis
author Fardousi, Nasser
author_facet Fardousi, Nasser
Silva, Everton Nunes da
Kovacs, Roxanne
Borghi, Josephine
Barreto, Jorge Otávio Maia
Kristensen, Søren Rud
Sampaio, Juliana
Shimizu, Helena Eri
Gomes, Luciano Bezerra
Russo, Letícia Xander
Gurgel, Garibaldi Dantas
Powell-Jackson, Timothy
author_role author
author2 Silva, Everton Nunes da
Kovacs, Roxanne
Borghi, Josephine
Barreto, Jorge Otávio Maia
Kristensen, Søren Rud
Sampaio, Juliana
Shimizu, Helena Eri
Gomes, Luciano Bezerra
Russo, Letícia Xander
Gurgel, Garibaldi Dantas
Powell-Jackson, Timothy
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Fardousi, Nasser
Silva, Everton Nunes da
Kovacs, Roxanne
Borghi, Josephine
Barreto, Jorge Otávio Maia
Kristensen, Søren Rud
Sampaio, Juliana
Shimizu, Helena Eri
Gomes, Luciano Bezerra
Russo, Letícia Xander
Gurgel, Garibaldi Dantas
Powell-Jackson, Timothy
dc.subject.mesh.en_US.fl_str_mv Reimbursement, Incentive
Brazil
Family Health
Humans
Primary Health Care
Quality of Health Care
topic Reimbursement, Incentive
Brazil
Family Health
Humans
Primary Health Care
Quality of Health Care
Primary health care
Family health teams
Quality of health care
Reimbursement, incentive
Reembolso de Incentivo
Saúde da Família
Atenção Primária à Saúde
Qualidade da Assistência à Saúde
dc.subject.en.en_US.fl_str_mv Primary health care
Family health teams
Quality of health care
Reimbursement, incentive
dc.subject.decs.en_US.fl_str_mv Reembolso de Incentivo
Saúde da Família
Atenção Primária à Saúde
Qualidade da Assistência à Saúde
description This research was funded by the Medical Research Council, Newton Fund and the Brazilian National Council for the States Funding Agencies (CONFAP) under the UK to Brazil Joint Health Systems Research Call (grant MR/R022828/1). The MRC grant was awarded to JB and TPJ. Funding from CONFAP came from Fundac¸ão de Amparo à Pesquisa do Distrito Federal (FAPDF), Fundac¸ão de Amparo à Ciência e Tecnologia do Estado de Pernambuco (FACEPE) and Fundac¸ão de Apoio à Pesquisa do Estado da Paraı ´ba (FAPESQ). CONFAP funding was awarded to ES. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
publishDate 2022
dc.date.issued.fl_str_mv 2022
dc.date.accessioned.fl_str_mv 2023-07-02T23:38:02Z
dc.date.available.fl_str_mv 2023-07-02T23:38:02Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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dc.identifier.citation.fl_str_mv FARDOUSI, Nasser et al. Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis. Plos Medicine, [San Francisco], v. 19, n. 7, e1004033, jul. 2022.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/59350
dc.identifier.issn.en_US.fl_str_mv 1549-1277
dc.identifier.other.none.fl_str_mv PMC9262241
35797409
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pmed.1004033
dc.identifier.eissn.none.fl_str_mv 1549-1676
identifier_str_mv FARDOUSI, Nasser et al. Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: a difference-in-differences analysis. Plos Medicine, [San Francisco], v. 19, n. 7, e1004033, jul. 2022.
1549-1277
PMC9262241
35797409
10.1371/journal.pmed.1004033
1549-1676
url https://www.arca.fiocruz.br/handle/icict/59350
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
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collection Repositório Institucional da FIOCRUZ (ARCA)
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