Effect of More Doctors (<i>Mais Médicos</i>) Program on geographic distribution of primary care physicians

Russo, Letícia Xander

doi:10.1590/1413-81232021264.26932020

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Sumário

FREE THEMES • Ciênc. saúde coletiva 26 (4) • Apr 2021 • https://doi.org/10.1590/1413-81232021264.26932020 copy

Effect of More Doctors (Mais Médicos) Program on geographic distribution of primary care physicians

Efeito do Programa Mais Médicos na distribuição geográfica dos médicos na atenção básica

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study assesses the effect of More Doctors Program (Programa Mais Médicos - PMM) on the equality in the distribution of primary care physicians (PCPs) in Brazil. Spatial data analysis, Lorenz curve and Gini coefficient were used to evaluate the geographic distribution of PCPs before and after the implementation of PMM (2012 and 2016). Data from 5,564 municipalities were used in the analyses. The results indicate that the distribution of PCPs has become more equal after PMM implementation. Between 2012 and 2016, overall Gini coefficient decreased by 11% from 0.255 to 0.227. At the state level, a statistically significant trend towards a more equal distribution of PCPs was found in 21 out of 26 Brazilian states. However, there still remains a substantial difference in the level of equality in PCP distribution, especially across states, with Gini coefficient ranging from 0.093 to 0.341 in 2016.

Key words
Physicians; Primary Health Care; Healthcare Disparities; Health Workforce

Region/State^b b Acre (AC), Alagoas (AL), Amapá (AP), Amazonas (AM), Bahia (BA), Ceará (CE), Espírito Santo (ES), Goiás (GO), Maranhão (MA), Mato Grosso (MT), Mato Grosso do Sul (MS), Minas Gerais (MG), Pará (PA), Paraíba (PB), Paraná (PR), Pernambuco (PE), Piauí (PI), Rio de Janeiro (RJ), Rio Grande do Norte (RN), Rio Grande do Sul (RS), Rondônia (RO), Roraima (RR), Santa Catarina (SC), São Paulo (SP), Sergipe (SE), Tocantins (TO).	2012	2013	2014	2015	2016	Coefficient	p-value (robust S.E.)	% change (2012-2016)
Brazil	0.255	0.250	0.238	0.231	0.227	-0.007	<0.01	-11%
North	0.300	0.284	0.254	0.235	0.230	-0.019	<0.01	-23%
RO	0.304	0.250	0.227	0.199	0.191	-0.028	<0.05	-37%
AC	0.200	0.208	0.190	0.125	0.139	-0.020	<0.05	-30%
RR	0.178	0.190	0.192	0.139	0.125	-0.016	<0.10	-30%
AM	0.259	0.252	0.190	0.185	0.189	-0.021	<0.05	-27%
PA	0.347	0.336	0.290	0.272	0.262	-0.023	<0.01	-24%
TO	0.200	0.191	0.168	0.162	0.170	-0.009	<0.10	-15%
AP	0.155	0.155	0.178	0.176	0.140	-0.001	0.899	-9%
Southeast	0.315	0.307	0.292	0.280	0.271	-0.011	<0.01	-14%
ES	0.239	0.222	0.191	0.181	0.182	-0.016	<0.05	-24%
SP	0.412	0.404	0.374	0.348	0.341	-0.020	<0.01	-17%
RJ	0.277	0.273	0.237	0.236	0.237	-0.012	<0.05	-14%
MG	0.239	0.230	0.225	0.223	0.213	-0.006	<0.01	-11%
Northeast	0.178	0.175	0.160	0.157	0.155	-0.006	<0.01	-13%
SE	0.200	0.211	0.160	0.137	0.142	-0.019	<0.05	-29%
CE	0.191	0.168	0.139	0.141	0.137	-0.014	<0.05	-28%
PE	0.183	0.172	0.159	0.151	0.148	-0.009	<0.01	-19%
BA	0.203	0.192	0.174	0.169	0.165	-0.010	<0.01	-19%
AL	0.152	0.158	0.145	0.138	0.128	-0.007	<0.05	-16%
PI	0.109	0.117	0.097	0.094	0.093	-0.006	<0.05	-15%
MA	0.168	0.170	0.147	0.141	0.144	-0.008	<0.05	-14%
RN	0.170	0.164	0.152	0.162	0.156	-0.003	<0.10	-8%
PB	0.121	0.114	0.120	0.123	0.122	0.001	0.399	1%
South	0.264	0.261	0.255	0.246	0.245	-0.005	<0.01	-7%
RS	0.318	0.312	0.296	0.284	0.284	-0.010	<0.01	-11%
PR	0.232	0.234	0.229	0.217	0.217	-0.005	<0.05	-6%
SC	0.204	0.200	0.211	0.211	0.204	0.001	0.437	0%
Midwest	0.223	0.224	0.233	0.237	0.234	0.004	<0.05	5%
MS	0.200	0.182	0.178	0.154	0.160	-0.011	<0.05	-20%
GO	0.228	0.226	0.245	0.249	0.247	0.006	<0.05	9%
MT	0.214	0.231	0.227	0.241	0.229	0.004	0.24	7%

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[1] Chief Editors: Romeu Gomes, Antônio Augusto Moura da Silva