Eficiência da atenção primária à saúde na Paraíba: uma análise a partir da fronteira estocástica de produção no período de 2012 a 2022

Abstract

This thesis evaluates the efficiency of Primary Health Care (PHC) in the state of Paraíba from 2012 to 2022. Paraíba has a Primary Care coverage rate of 97.83%, making it a health service present in all 223 municipalities. Since the creation of the Unified Health System (SUS), the Ministry of Health has acted as a driver and promoter, encouraging municipalities to take responsibility for primary care. To this end, it has employed financing mechanisms ranging from the calculation of fixed and variable funding to the conditioning of user enrollment and target achievement, the latter being the most recent through the Previne Brasil program. In 2017, the National Primary Care Policy underwent a reformulation, reinforcing the need for evaluation of these health services. To conduct the study, global and local Moran spatial autocorrelation analyses were performed. Subsequently, the overall efficiency of PHC was estimated using the stochastic frontier production method for panel data, categorizing municipalities according to population size, thus forming three estimation scenarios: small-sized, medium-sized, and a specific case for a large-sized municipality. Finally, an assessment was conducted on exogenous health-related variables and their relationship with PHC efficiency using the Tobit model. The results indicated technical efficiency scores of 0.51, 0.54, and 0.49 for the three scenarios, respectively. The variables per capita PHC expenditure, the number of nurses per inhabitant, and the distance to urgent care units showed a positive relationship with technical efficiency, while the number of Community Health Agents (ACS) and Basic Health Units (UBS) per inhabitant, as well as the presence of hospital beds, were negatively associated. Regarding exogenous variables, the number of benefits provided by the Bolsa Família program was negatively associated with PHC efficiency. Finally, efficiency calculations demonstrate that, overall, the state of Paraíba falls below the estimated values for Brazil. However, the positive results obtained can serve as a reference for implementing improvements through benchmarking.