O impacto da atenção básica em saúde em indicadores de internação hospitalar no Brasil

The main purpose of this work was to assess how the expansion of pri mary health care has affected the rates of hospitalization due to ambul atory care sensitive conditions, the duration of admissions and the public resources involved. This is an empirical assessment of the effectiveness of primary health c re, which develops as an ecological study, with municipalities in the country being the cros s-sectional units. The analyses cover the years 2000 until 2007. A two-way fixed effects m odel has been used, applied to a panel data set, which captures the fixed effects f or each municipality and the specific effects of each year in particular intercepts. The dependent variables were the rates of hospital admissions and of hospital stay and the amounts of money spent with these hospitalizations. The explanatory variables were the percentage of coverage of family health teams; of community health agents, and of registration of the populat i n in the Family Health Strategy. The following control variables were also inc luded: GDP per capita, employed population, coverage of formal education, municipalities' o wn resources invested in health, hospital beds by the Unified Health System, coverage of health insurances; medical consultations per capita, and annual dummies. The estimation results showed that variables representing the coverage of family health teams a nd the registration of the population are associated with lower rates of hospitalization for c ongestive heart failure and sensitive conditions in general. The coverage of community health a gents was only associated with the reduction of hospital admissions in the Southeast. In the North and Northeast the results showed the opposite, the more the coverage of com munity health agents increased, the more hospital admissions raised. The rate of hospitalization for acute diarrhea in children under 5 years was only negatively affected by increased coverage of the family health teams, but in the Northeast, the opposite effect was observed, caused by the coverage of community health agents. All the explanatory variables r epresenting the expansion of primary care proved to be negatively associated wit h hospitalizations for stroke in the population aged 40 or over in the municipalities with more than 60 thousand inhabitants. With regard to the hospitalizations for diabetes mellit us, a negative association was observed between increased coverage of the family health tea ms and registration of the population, but only for cities that had more than 99% of the population residi ng in urban areas. The increase in the number of family health teams and in the level of registration of the population was also related to diminished hospital stays as well as to the amounts of money involved in these hospitalizations. In general, the results obta ined in the estimations of effects of the coverage of family health teams and regist ation of the population support the dominant theoretical perspective according to which primary car e is associated with a decrease in hospitalizations. However, the association of coverage of th community health agents with increased municipalities hospitalization rates in the North and Northeast may also indicate that primary care is also functioning as an eleme nt capable of providing necessary hospitalizations in areas deprived of health services.