Pay for performance in Brazilian primary health care: quality of work processes, actions and services

Abstract

PurposeIn 2011, Brazil introduced a national pay-for-performance (P4P) scheme called the National Program for Improving Primary Health Care Access and Quality (PMAQ), rolled out over three cycles and reaching more than 5,000 municipalities and 40,000 family health teams (FHTs). There is little evidence on how the PMAQ was implemented locally and whether this variation in implementation affects performance, particularly, in terms of work process indicators. This study compared different cases of municipal-level PMAQ implementation (bonuses paid or not to FHTs) over the last two program cycles to analyze the quality of the work processes, actions and services of FHTs.Design/methodology/approachThis was a cross-sectional analytical study using secondary data from an external evaluation of the Brazilian PMAQ. In total, 27,500 FHTs participated in the evaluation. They were divided into four clusters based on whether or not municipalities paid bonuses to workers during cycles 2 and 3 of the program (2013–2019). Variables regarding work processes, actions and services were classified as “Quality Assurance – QA” or “Continued Quality Improvement – CQI”, and an individual score was assigned based on the average score of each variable.FindingsThe four clusters displayed an increase in overall QA and CQI scores between the two program cycles; though this increase was small between the set of primary health care teams that received bonuses and those that did not.Originality/valueThis paper contributes to bridging the gap in the scientific literature for evaluative studies on the relationship between direct payment for performance to health professionals and better quality actions and services in low and middle-income countries.

Guest editorial: Payment for performance: comparing policy making, design and implementation in health, social care and education

“…This special issue gathers three types of comparative studies: cross-country comparisons (Zitti et al , 2023; Andersen, 2023), intra country comparisons (Aktas et al , 2023; Srinivasan and Sarin, 2023; Coelho et al , 2023; Dos Anjos et al , 2023) and world-wide meta-analysis from existing literature (Kristensen et al , 2023; Briganti et al, 2023 ). Authors carry out policy process analyses, employing qualitative, mixed methods and review techniques, combined with comparative analytical descriptive accounts.…”

“…Another block of four papers develops in depth single country studies, breaking the analysis into smaller analytical units in different locations, examining sub-national or sub-regional aspects or administrative variations within a country. They develop cases analysis of original or new data focusing on Turkey (Aktas et al , 2023), India (Srinivasan and Sarin, 2023) and Brazil (Coelho et al , 2023; Dos Anjos et al , 2023).…”

“…The paper by dos Anjos et al (2023) analyses the relationship between performance payments for professionals and the improvement of primary health services, based on the Brazilian experience. Based on a cross-sectional analysis, with data from 27.5 thousand Family Health teams, collected at two moments (2013/2019), the authors classified contexts in which there was or was not the use of P4P mechanisms and compared its effects on the quality of services offered to the population.…”