Primary health care coverage in Brazil: Assessment of the Family Health Program impacts on mortality at municipality level

The main purpose of this paper is to analyse the direct impacts of Family Health Strategy / Program (PSF) on mortality related to diseases / conditions for which access to effective primary care can reduce the likelihood of more severe outcomes and quality of vital information (Chap 18 of ICD 10). The measure of coverage is the number of teams deployed by population. We worked with individual data from the Brazilian Ministry of Health (Datasus) aggregated to municipal level. To address the endogeneity of the coverage, we estimated a fixed effect model with instrumental variables. The instruments employed are dummies that capture the political alignment between majors and the state governor, between majors and the president, and between state governor and the president. Our results show no significant effects for stroke, asthma, other diseases from respiratory tract and kidney diseases. On the other hand, there are significant effects for conditions related to Brazilian list of avoidable hospital admissions, hypertension and diabetes, coronary disease, cardiac insufficiency, diabetes complications and bacterial pneumonia, indicating that PSF is effective in reducing avoidable mortality for that causes. The results obtained for some metropolitan region municipalities suggest that it seems that heterogeneities may exist.