From policy to practice: an analysis of health initiatives in Espírito Santo, Brazil

Date and time:  Tuesday 30 September, 15:30 hours

Location: L1 Main Meeting Room, Richard Doll Building, Old Road Campus, Headington, OX3 7LF

To Join: This is a free event, which will be taking place both in-person and online via Zoom/Microsoft Teams. Register

Abstract: This study evaluates the impacts of Brazil’s Programa Mais Médicos (PMM), Qualifica-APS, and the Access and Quality Management Program for Healthcare Networks (PGAQ) on healthcare outcomes in Espírito Santo, Brazil, from 2008 to 2024. The primary focus of the first paper is assessing hospitalizations for ambulatory care-sensitive conditions (ACSC) across 78 municipalities, while the second paper evaluates hospital efficiency in PGAQ-participating hospitals. Both studies employ the Generalized Synthetic Control (GSC) method to construct robust counterfactuals for causal inference. The ACSC analysis also uses a flexible difference-in-differences (FLEX DiD) framework to account for staggered program implementation, leveraging a dataset of 15,912 observations and 33 variables, including ACSC hospitalizations, physician availability under PMM and Qualifica-APS (initiated around 2013 and 2019, respectively), GDP per capita, Human Development Index (HDI), healthcare infrastructure, population demographics, poverty proxies, and primary care coverage. Stakeholder input from health policymakers and practitioners informed variable selection, ensuring a robust analytical framework. For the PGAQ evaluation, GSC is combined with Data Envelopment Analysis (DEA) to assess hospital efficiency metrics, including bed occupancy rates, average length of stay (ALS), and mortality rates. Key PGAQ components—Internal Regulation Centers (NIR), Hospitalist Medicine (MH) and Discharge Management Offices (EGA)—are examined for their roles in optimizing bed management, reducing hospital stay durations, and enhancing patient outcomes. This integrated approach establishes a standardized dataset and methodological framework, laying the groundwork for evidence-based strategies to strengthen primary care and hospital performance across Brazilian municipalities.

Bio: César Malaguti is a Ph.D. Candidate in Economics at the Federal University of Espírito Santo (UFES) and a Visiting Researcher at the Health Economics Research Centre (HERC) at the University of Oxford. His work focuses on using rigorous research to inform and improve public health policy. Since 2021, he has worked in public health policy in Espírito Santo, Brazil, where he currently serves as the State Coordinator of Public Health Policies. In this role, a partnership between the State Secretariat of Management and Human Resources (SEGER) and the State Secretariat of Health (SESA), he designs and implements statewide initiatives. His recent applied work includes a policy he designed and implemented in 2023 that focuses on occupational health, safety, and quality of life at work. César received his bachelor's degree in Economics from the Federal University of Juiz de Fora (UFJF) in 2019 and a master's in Applied Economics in 2023. His master's research used econometric models to examine the impact of COVID-19 on the insurance market. His doctoral research at UFES evaluates the effectiveness of health policies in Espírito Santo, with a focus on medical services and hospital management.