Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba
Autor(a) principal: | |
---|---|
Data de Publicação: | 2021 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFPB |
Texto Completo: | https://repositorio.ufpb.br/jspui/handle/123456789/22512 |
Resumo: | The management process in primary care has undergone changes in recent decades. One of them was the payment-for-performance process of the Access and Quality Improvement in Primary Care Program (PMAQ-AB), which innovated the method of transferring resources to primary care, adding the quality indicator to assess the teams. The PMAQ-AB allocated financial resources to the municipality according to the performance evaluation of the teams participating in the program, regarding the quality and access of services offered to the population. However, the program did not define how these resources should be applied at the municipal level, leaving the municipalities to agree locally, through laws, decrees or ordinances created for this purpose. The PMAQ-AB had its end decreed in the year 2019. This study aims to analyze the management of resources of the PMAQ-AB and its relationship with the performance of municipalities in Paraíba participating in the program. This is a descriptive, cross-sectional, analytical research with a quantitative approach, with 219 municipal managers. The results of this work came from two databases. The data underwent an exploratory descriptive analysis and the use of the logistic regression model. The results were presented in two-article format. The first article was descriptive and portrayed how the transfer of resources occurred in the three evaluation cycles. The article showed that most municipalities in Paraíba have adopted a municipal law as a rule to regulate the use of financial incentives under the PMAQ-AB. External evaluation was the main criterion for transferring financial resources to the health teams. During the cycles, more actors received resources in addition to the minimum team of the family health strategy and the transfer was made on a biannual and annual basis, with around 40% to 50% of the amount allocated to the teams and the remainder invested in improvements to the work conditions. The second article, on the other hand, was used only with data referring to the third cycle of the program's evaluation and pointed out, through the logistic regression model, which municipalities used the criterion of the result of the external evaluation to transfer resources; they transferred resources to the support/manager beyond the minimum team of the family health strategy; adopted the monthly frequency for transfer and transferred a percentage of 0 to 20% of the value of resources to the teams, had more chances of having a better performance in the PMAQ-AB certification. It is concluded that this research allowed the identification of relevant aspects about how the PMAQ-AB resources were implemented at the local level by the municipalities of a state with high ESF coverage and broad adherence to the Program. In addition, it allowed the identification of more relevant ways to transfer resources, in order to achieve better results from primary care teams. This allows for the identification of potential vectors to be considered by the managers of the three spheres in future pay-for-performance policies, which gain greater relevance at a time when the PMAQ-AB, as a form of composition of funding for primary care, was discontinued. |
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Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na ParaíbaPagamento por performanceFinanciamento da atenção básicaGestão municipalPMAQ-ABPay for performanceFinancing of primary careMunicipal managementCNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVAThe management process in primary care has undergone changes in recent decades. One of them was the payment-for-performance process of the Access and Quality Improvement in Primary Care Program (PMAQ-AB), which innovated the method of transferring resources to primary care, adding the quality indicator to assess the teams. The PMAQ-AB allocated financial resources to the municipality according to the performance evaluation of the teams participating in the program, regarding the quality and access of services offered to the population. However, the program did not define how these resources should be applied at the municipal level, leaving the municipalities to agree locally, through laws, decrees or ordinances created for this purpose. The PMAQ-AB had its end decreed in the year 2019. This study aims to analyze the management of resources of the PMAQ-AB and its relationship with the performance of municipalities in Paraíba participating in the program. This is a descriptive, cross-sectional, analytical research with a quantitative approach, with 219 municipal managers. The results of this work came from two databases. The data underwent an exploratory descriptive analysis and the use of the logistic regression model. The results were presented in two-article format. The first article was descriptive and portrayed how the transfer of resources occurred in the three evaluation cycles. The article showed that most municipalities in Paraíba have adopted a municipal law as a rule to regulate the use of financial incentives under the PMAQ-AB. External evaluation was the main criterion for transferring financial resources to the health teams. During the cycles, more actors received resources in addition to the minimum team of the family health strategy and the transfer was made on a biannual and annual basis, with around 40% to 50% of the amount allocated to the teams and the remainder invested in improvements to the work conditions. The second article, on the other hand, was used only with data referring to the third cycle of the program's evaluation and pointed out, through the logistic regression model, which municipalities used the criterion of the result of the external evaluation to transfer resources; they transferred resources to the support/manager beyond the minimum team of the family health strategy; adopted the monthly frequency for transfer and transferred a percentage of 0 to 20% of the value of resources to the teams, had more chances of having a better performance in the PMAQ-AB certification. It is concluded that this research allowed the identification of relevant aspects about how the PMAQ-AB resources were implemented at the local level by the municipalities of a state with high ESF coverage and broad adherence to the Program. In addition, it allowed the identification of more relevant ways to transfer resources, in order to achieve better results from primary care teams. This allows for the identification of potential vectors to be considered by the managers of the three spheres in future pay-for-performance policies, which gain greater relevance at a time when the PMAQ-AB, as a form of composition of funding for primary care, was discontinued.NenhumaO processo de gestão na atenção básica tem passado por mudanças nas últimas décadas. Uma delas foi o processo de pagamento por desempenho do Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB) que inovou o método de transferência de recurso para a atenção básica, adicionando o indicador de qualidade para avaliar as equipes. O PMAQ-AB atribuía recursos financeiros para o município de acordo com a avaliação de desempenho das equipes participantes do programa, quanto a qualidade e acesso de serviços ofertados à população. Contudo, o programa não definia como esses recursos deveriam ser aplicados no âmbito municipal, ficando a cargo dos municípios pactuar localmente, através de leis, decretos ou portarias criadas com essa finalidade. O PMAQ-AB teve seu fim decretado no ano de 2019. Este estudo tem como objetivo analisar a gestão de recursos do PMAQ-AB e sua relação com o desempenho dos municípios da Paraíba participantes do programa. Trata-se de uma pesquisa descritiva, transversal, analítica com abordagem quantitativa, com 219 gestores municipais. Os resultados desse trabalho se deram a partir de duas bases de dados. Os dados passaram por uma análise descritiva exploratória e a utilização do modelo de regressão logística. Os resultados foram apresentados em formato de dois artigos. O primeiro artigo foi descritivo e retratou como ocorreu o repasse dos recursos nos três ciclo de avaliação. O artigo mostrou que a maioria dos municípios da Paraíba adotou lei municipal como normativa para regulamentar o uso dos incentivos financeiros do PMAQ-AB. A avaliação externa foi o principal critério de repasse dos recursos financeiros às equipes de saúde. No decorrer dos ciclos, mais atores receberam recursos além da equipe mínima da estratégia de saúde da família e o repasse foi feito de forma semestral e anual, sendo cerca de 40% a 50% do valor destinado às equipes e o restante investido em melhorias das condições de trabalho. Já o segundo artigo foi utilizado apenas com os dados referentes ao terceiro ciclo de avaliação do programa e apontou através do modelo de regressão logística que municípios que usaram o critério do resultado da avaliação externa para repasse dos recursos; repassavam recursos para o apoio/gerente além da equipe mínima da estratégia de saúde da família; adotavam a periodicidade mensal para repasse e repassavam uma porcentagem de 0 a 20% do valor dos recursos para as equipes, possuíam mais chances de ter um melhor desempenho na certificação do PMAQ-AB. Conclui-se que esta pesquisa permitiu identificar aspectos relevantes sobre como se deu a execução em nível local dos recursos do PMAQ-AB por parte dos municípios de um estado com elevada cobertura de ESF e ampla adesão ao Programa. Além disso, permitiu identificar formas mais relevantes para o repasse dos recursos, afim de conseguir melhores resultados das equipes de atenção básica. Isso permite identificar potenciais vetores a serem considerados pelos gestores das três esferas em futuras politicas de pagamento por desempenho, o que ganha maior relevância num momento em que o PMAQ-AB, como uma modalidade de composição do financiamento da atenção básica foi descontinuado.Universidade Federal da ParaíbaBrasilCiências Exatas e da SaúdePrograma de Pós-Graduação em Modelos de Decisão e SaúdeUFPBSampaio, Julianahttp://lattes.cnpq.br/8390769849429514Lima Filho, Luiz Medeiros de Araujohttp://lattes.cnpq.br/8680871640499952Rodrigues, André Wagner Dantas2022-03-24T19:10:25Z2022-02-072022-03-24T19:10:25Z2021-12-16info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesishttps://repositorio.ufpb.br/jspui/handle/123456789/22512porAttribution-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nd/3.0/br/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFPBinstname:Universidade Federal da Paraíba (UFPB)instacron:UFPB2022-04-05T17:40:36Zoai:repositorio.ufpb.br:123456789/22512Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufpb.br/PUBhttp://tede.biblioteca.ufpb.br:8080/oai/requestdiretoria@ufpb.br|| diretoria@ufpb.bropendoar:2022-04-05T17:40:36Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB)false |
dc.title.none.fl_str_mv |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
title |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
spellingShingle |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba Rodrigues, André Wagner Dantas Pagamento por performance Financiamento da atenção básica Gestão municipal PMAQ-AB Pay for performance Financing of primary care Municipal management CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
title_short |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
title_full |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
title_fullStr |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
title_full_unstemmed |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
title_sort |
Pagamento por performance: uma análise da gestão dos recursos financeiros do PMAQ-AB na Paraíba |
author |
Rodrigues, André Wagner Dantas |
author_facet |
Rodrigues, André Wagner Dantas |
author_role |
author |
dc.contributor.none.fl_str_mv |
Sampaio, Juliana http://lattes.cnpq.br/8390769849429514 Lima Filho, Luiz Medeiros de Araujo http://lattes.cnpq.br/8680871640499952 |
dc.contributor.author.fl_str_mv |
Rodrigues, André Wagner Dantas |
dc.subject.por.fl_str_mv |
Pagamento por performance Financiamento da atenção básica Gestão municipal PMAQ-AB Pay for performance Financing of primary care Municipal management CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
topic |
Pagamento por performance Financiamento da atenção básica Gestão municipal PMAQ-AB Pay for performance Financing of primary care Municipal management CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
description |
The management process in primary care has undergone changes in recent decades. One of them was the payment-for-performance process of the Access and Quality Improvement in Primary Care Program (PMAQ-AB), which innovated the method of transferring resources to primary care, adding the quality indicator to assess the teams. The PMAQ-AB allocated financial resources to the municipality according to the performance evaluation of the teams participating in the program, regarding the quality and access of services offered to the population. However, the program did not define how these resources should be applied at the municipal level, leaving the municipalities to agree locally, through laws, decrees or ordinances created for this purpose. The PMAQ-AB had its end decreed in the year 2019. This study aims to analyze the management of resources of the PMAQ-AB and its relationship with the performance of municipalities in Paraíba participating in the program. This is a descriptive, cross-sectional, analytical research with a quantitative approach, with 219 municipal managers. The results of this work came from two databases. The data underwent an exploratory descriptive analysis and the use of the logistic regression model. The results were presented in two-article format. The first article was descriptive and portrayed how the transfer of resources occurred in the three evaluation cycles. The article showed that most municipalities in Paraíba have adopted a municipal law as a rule to regulate the use of financial incentives under the PMAQ-AB. External evaluation was the main criterion for transferring financial resources to the health teams. During the cycles, more actors received resources in addition to the minimum team of the family health strategy and the transfer was made on a biannual and annual basis, with around 40% to 50% of the amount allocated to the teams and the remainder invested in improvements to the work conditions. The second article, on the other hand, was used only with data referring to the third cycle of the program's evaluation and pointed out, through the logistic regression model, which municipalities used the criterion of the result of the external evaluation to transfer resources; they transferred resources to the support/manager beyond the minimum team of the family health strategy; adopted the monthly frequency for transfer and transferred a percentage of 0 to 20% of the value of resources to the teams, had more chances of having a better performance in the PMAQ-AB certification. It is concluded that this research allowed the identification of relevant aspects about how the PMAQ-AB resources were implemented at the local level by the municipalities of a state with high ESF coverage and broad adherence to the Program. In addition, it allowed the identification of more relevant ways to transfer resources, in order to achieve better results from primary care teams. This allows for the identification of potential vectors to be considered by the managers of the three spheres in future pay-for-performance policies, which gain greater relevance at a time when the PMAQ-AB, as a form of composition of funding for primary care, was discontinued. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-12-16 2022-03-24T19:10:25Z 2022-02-07 2022-03-24T19:10:25Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
format |
masterThesis |
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publishedVersion |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufpb.br/jspui/handle/123456789/22512 |
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https://repositorio.ufpb.br/jspui/handle/123456789/22512 |
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por |
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por |
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Attribution-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nd/3.0/br/ info:eu-repo/semantics/openAccess |
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Attribution-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nd/3.0/br/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Ciências Exatas e da Saúde Programa de Pós-Graduação em Modelos de Decisão e Saúde UFPB |
publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Ciências Exatas e da Saúde Programa de Pós-Graduação em Modelos de Decisão e Saúde UFPB |
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reponame:Biblioteca Digital de Teses e Dissertações da UFPB instname:Universidade Federal da Paraíba (UFPB) instacron:UFPB |
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Universidade Federal da Paraíba (UFPB) |
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UFPB |
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UFPB |
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Biblioteca Digital de Teses e Dissertações da UFPB |
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Biblioteca Digital de Teses e Dissertações da UFPB |
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Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB) |
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