Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil

Abstract Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based...

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Autores principales:	Fernando Antonio Slaibe Postali, Maria Dolores Montoya Diaz, Natalia Nunes Ferreira-Batista, Adriano Dutra Teixeira, Rodrigo Moreno-Serra
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Primary care Biomarkers Probit Impact evaluation Universal health care Low- to middle-income countries Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/d9f61171b3bf4e6f972c47e5995c540f
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spelling	oai:doaj.org-article:d9f61171b3bf4e6f972c47e5995c540f2021-12-05T12:06:55ZPrimary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil10.1186/s12913-021-07329-91472-6963https://doaj.org/article/d9f61171b3bf4e6f972c47e5995c540f2021-12-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07329-9https://doaj.org/toc/1472-6963Abstract Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.Fernando Antonio Slaibe PostaliMaria Dolores Montoya DiazNatalia Nunes Ferreira-BatistaAdriano Dutra TeixeiraRodrigo Moreno-SerraBMCarticlePrimary careBiomarkersProbitImpact evaluationUniversal health careLow- to middle-income countriesPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Primary care Biomarkers Probit Impact evaluation Universal health care Low- to middle-income countries Public aspects of medicine RA1-1270
spellingShingle	Primary care Biomarkers Probit Impact evaluation Universal health care Low- to middle-income countries Public aspects of medicine RA1-1270 Fernando Antonio Slaibe Postali Maria Dolores Montoya Diaz Natalia Nunes Ferreira-Batista Adriano Dutra Teixeira Rodrigo Moreno-Serra Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
description	Abstract Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.
format	article
author	Fernando Antonio Slaibe Postali Maria Dolores Montoya Diaz Natalia Nunes Ferreira-Batista Adriano Dutra Teixeira Rodrigo Moreno-Serra
author_facet	Fernando Antonio Slaibe Postali Maria Dolores Montoya Diaz Natalia Nunes Ferreira-Batista Adriano Dutra Teixeira Rodrigo Moreno-Serra
author_sort	Fernando Antonio Slaibe Postali
title	Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
title_short	Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
title_full	Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
title_fullStr	Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
title_full_unstemmed	Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil
title_sort	primary care coverage and individual health: evidence from a likelihood model using biomarkers in brazil
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d9f61171b3bf4e6f972c47e5995c540f
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_version_	1718372284716023808

Primary care coverage and individual health: evidence from a likelihood model using biomarkers in Brazil

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