Policies for expanding access to higher education and changing the profile of medical graduates in Brazil: a cross-sectional study

Figueiredo, Alexandre Medeiros de; Lima, Kenio Costa de; Massuda, Adriano; Azevedo, George Dantas de

doi:10.1590/1413-81232022279.07092022

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FREE THEMES • Ciênc. saúde coletiva 27 (09) • Sept 2022 • https://doi.org/10.1590/1413-81232022279.07092022EN linkcopy

Policies for expanding access to higher education and changing the profile of medical graduates in Brazil: a cross-sectional study

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This study assesses the effectiveness of policies to expand access to higher education in reducing inequities in the profile of graduates from medical courses in Brazil. This work consists of a cross-sectional study using data from the 2018 Higher Education Census. Analyses were carried out to identify the association between being a beneficiary of the Quota Law, the University for All Program, or the Student Financing Fund and three markers: born in a small-sized municipality, being non-white, or having attended high school in a public school. Analyses were performed using Pearson’s chi-square test, and multivariate analysis was conducted using Poisson regression. A significant association was found between being a beneficiary of these policies and being a non-white graduate, who was born in a small town and who had studied in a public high school. All policies presented adjusted Prevalence Ratio (PR), which demonstrated an association with statistical significance. The Quota Law was the most effective policy, with RP=1.92 for non-white graduates, RP=6.66 for having studied in a public high school, and RP=1.08 for being born in a small town. Despite these results, these groups remain underrepresented in medical courses and in the workforce.

Key words:
Workforce; Medical Education; Public Policy; Socioeconomic factors; Social Segregation

Characteristics of graduates		Public Universities		Private Universities		Total
Characteristics of graduates		n	%	n	%	n	%
Sex
	Male	3553	48.38	4630	38.94	8183	42.54
	Female	3791	51.62	7260	61.06	11051	57.46
Age range
	Aged 26 years or under	4686	63.81	7231	60.82	11917	61.96
	Aged 27 years or over	2658	36.19	4659	39.18	7317	38.04
Entered through Quota System
	No	6220	84.69	11871	99.84	18091	94.06
	Yes	1124	15.31	19	0.16	1143	5.94
FIES user
	No	7248	98.69	6107	51.36	13355	69.43
	Yes	96	1.31	5783	48.64	5879	30.57
PROUNI beneficiary
	No	7344	100.00	11237	94.51	18,581	96.60
	Yes	0	0.00	653	5.49	6.53	3.40
Type of high school
	Private	4853	66.08	9016	75.83	13869	72.11
	Public	2040	27.78	2570	21.61	4610	23.97
	No information	451	6.14	304	2.56	755	3.93
Race/color
	White	3648	49.67	7287	61.29	10935	56.85
	Non-White	2048	27.89	2364	19.88	4412	22.94
	No information	1648	22.44	2239	18.83	3887	20.21
Born in a town with less than 20,000 inhabitants
	No	4677	63.68	9822	82.61	14499	75.38
	Yes	307	4.18	731	6.15	1038	5.40
	No information	2360	32.14	1337	11.24	3697	19.22

Characteristics of graduates	Missing data
	Race/color		Type of high school		Place of birth
	n (%)	p-value	n (%)	p-value	n (%)	p-value
Sex
Male	1657 (20.2)	>0.05	361 (4.4)	<0.05	1665 (20.3)	<0.01
Female	2230 (20.2)		394 (3.6)		2032 (18.4)
Age
Up to 26 years	2237 (18.8)	<0.01	376 (3.2)	<0.01	2297 (19.3)	>0.05
27 years or over	1650 (22.6)		379 (5.2)		1400 (19.1)
Administrative category
Private	2239 (18.8)	<0.01	451 (6.1)	<0.01	1337 (32.1)	<0.01
Public	1648 (22.4)		304 (2.6)		2360 (11.2)
Entered through Quota System
No	3695 (20.4)	<0.01	741 (4.1)	<0.01	3358 (18.6)	<0.01
Yes	192 (16.8)		14 (1.2)		339 (29.7)
FIES user
No	2567 (19.2)	<0.01	561 (4.2)	<0.05	3022 (22.6)	<0.01
Yes	1320 (22.5)		194 (3.3)		675 (11.5)
PROUNI beneficiary
No	3762 (20.2)	<0.05	732 (3.9)	>0.05	3630 (19.5)	<0.01
Yes	125 (19.1)		23 (3.5)		67 (10.3)
Total

Characteristics of graduates	Race/color				p-value
	White		Non-White
	n	(%)	n	(%)
Sex
Male	4531	69.43	1995	30.57	p<0.001
Female	6404	72.60	2417	27.40
Age
Up to 26 years	7153	73.89	2527	26.11	p<0.001
27 years or over	3782	66.74	1885	33.26
Administrative catergory of medical school
Private	7287	75.51	2364	24.49	p<0.001
Public	3648	64.04	2048	35.96
Entered through Quota System
No	10595	73.60	3801	26.40	p<0.001
Yes	340	35.75	611	64.25
FIES beneficiary
No	7652	70.93	3136	29.07	p>0.05
Yes	3283	72.01	1276	27.99
PROUNI beneficiary
No	10651	71.87	4168	28.13	p<0.001
Yes	284	53.79	244	46.21
Total	10935	71.25	4412	28.75

Characteristics of graduates	Type of high school				p-value
	Private		Public
	n	(%)	n	(%)
Sex
Male	5751	73.52	2071	26.48	p<0.001
Female	8118	76.18	2539	23.82
Age
Up to 26 years	9052	78.43	2489	21.57	p<0.001
27 years or over	4817	69.43	2121	30.57
Administrative category of medical school
Private	9016	77.82	2570	22.18	p<0.001
Public	4853	70.40	2040	29.60
Entered through Quota System
No	13733	79.15	3617	20.85	p<0.001
Yes	136	12.05	993	87.95
FIES beneficiary
No	9422	73.64	3372	26.36	p<0.001
Yes	4447	78.22	1238	21.78
PROUNI beneficiary
No	13599	76.19	4250	23.81	p<0.001
Yes	270	42.86	360	57.14
Total	13869	75.05	4610	24.95

Characteristics of graduates	Population size of the place of birth				p-value
	More than 20,000 inhabitants		Up to 20,000 inhabitants
	n	(%)	n	(%)
Sex
Male	6,057	92.93	461	7.07	p >0.05
Female	8,442	93.60	577	6.40
Age
Up to 26 years	9,019	93.80	601	6.20	p < 0.01
27 years or over	5,480	92.60	437	7.40
Administrative category of medical school
Private	9,822	93.07	731	6.93	p >0.05
Public	4,677	93.84	307	6.16
Entered through Quota System
No	13,794	93.63	939	6.37	p<0.001
Yes	705	87.69	99	12.31
FIES beneficiary
No	9,718	94.05	615	5.95	p<0.001
Yes	4,781	91.87	423	8.13
PROUNI beneficiary
No	13,968	93.43	983	6.57	p < 0.01
Yes	531	90.61	55	9.39
Total	14,499	93.32	1,038	6.68

Characteristics of graduates	Non-white graduates			Graduates who studied in a public high school		Graduates born in a town with less than 20,000 inhabitants
Characteristics of graduates	PR (95% CI)	p-value	PR (95% CI)	p-value	PR (95% CI)	p-value
Age ≥ 27 years	1.10 (1.07-1.12)	p < 0.01	1.11 (1.09-1.13)	p < 0.01	1.01 (1.00-1.02)	p < 0.05
Male	1.03 (1.01-1.05)	p < 0.05	1.02 (1.00-1.03)	p < 0.05	1.01 (0.99-1.02)	p > 0.05
Entered through Quota System	1.92 (1.76-2.10)	p < 0.01	6.66 (5.68-7.80)	p < 0.01	1.08 (1.05-1.11)	p < 0.01
PROUNI beneficiary	1.46 (1.35-1.58)	p < 0.01	1.83 (1.67-2.01)	p < 0.01	1.04 (1.01-1.07)	p < 0.05
FIES user	1.11 (1.08-1.13)	p < 0.01	1.02 (1.00-1.04)	p <0.05	1.03 (1.02-1.04)	p < 0.01
Graduate from public university	1.16 (1.13-1.19)	p < 0.01	0.99 (0.97-1.01)	p > 0.05	0.99 (0.98-1.00)	p > 0.05

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