THE COMPREHENSIVE HEALTH IMPACT OF CASH TRANSFERS, SOCIAL PENSIONS AND PRIMARY CARE IN BRAZIL: AN ANALYSIS TO MITIGATE THE EFFECTS OF THE COVID19-RELATED ECONOMIC

Vol 2, 2022 - 163629
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Resumo

Brazil has some of the world`s largest Conditional Cash Transfer (Bolsa Familia Program-BFP), Social Pension (Benefício de Prestação Continuada-BPC), and Primary Health Care (Family Health Strategy–FHS) programs. We evaluated the impact of these interventions on health indicators, and forecasted their mitigation effects on the adverse health impact of the current COVID19-related economic crisis.

Objetivos

We evaluated the comprehensive effect of the Brazilian CCT, SP and PHC on morbidity and mortality of the population over the last two decades, and forecast their potential mitigation effects during the COVID19-related economic crisis and beyond.

Metodologia

In the retrospective impact evaluation, we used fixed-effects negative binomial models with a cohort of Brazilian municipalities from 2004-19 to estimate the impact of BFP, BPC, and FHS coverage on hospitalizations and mortality, adjusted for all relevant demographic, social, and economic factors. Subsequently, we integrated the longitudinal dataset and estimated parameters with validated dynamic microsimulation models, projecting hospitalization and mortality trends up to 2030 according to a range of potential intensities and durations of the economic crisis, as well as a range of alternative policy responses.

Resultados

Consolidated coverages of BFP, FHS, and BPC reduce the overall age-standardized mortality rate, with Rate Ratios of 0.94(95%CI:0.94-0.96), 0.93(95%CI:0.93-0.94), and 0.92(95%CI:0.91-0.92), respectively; stronger effects were found for under-five mortality, with RR of 0.87(95%CI:0.85-0.90), 0.90(95%CI:0.88-0.93), and 0.84(95%CI:0.82-0.86), respectively. A mitigation strategy that increases the coverage of the BFP, FHS, and BPC proportionally to the increase of poverty rates will avert 778,845 (95%CI:665,074- 893,674) deaths by 2030 if compared with the current coverage trends, and 1,424,624 (95%CI: 1,264,552 –1,587,859) deaths if compared with scenarios of fiscal austerity.

Conclusões/Considerações

The Brazilian cash transfer, social pension, and primary health care programs had a comprehensive and large impact on the country’s hospitalizations and mortality over the last two decades in the country. Moreover, using robust forecasting methods, we show that mitigation strategies could avert up to 1.4 million overall deaths and 170,000 under-five deaths over the next decade, when compared to commonly implemented fiscal austerity measures.

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  • Eixo 05 - A pandemia de COVID-19 e seus legados