gms | German Medical Science

Background: Public sector funding within the Brazilian health system was designed to promote universal healthcare coverage for the population. The emphasis on access to healthcare free of charge in the public sector poses substantial challenges to the health system management, particularly regarding involvement of patients in evaluation of healthcare. The National Program for Improvement of Access and Quality in Primary Health Care (PMAQ-AB) comprised initiative to promote focus in quality of care and patient satisfaction.

Objective: The objective of the study was to identify associations between dimensions of quality and resolubility of primary health care provided for the Brazilian population from 1998 to 2019, showing challenges in patient engagement to foster improvements of the national health system.

Methods: The study comprises quantitative analysis of cross-sectional surveys representative at population level, conducted by the Brazilian Institute for Geography and Statistics (IBGE) in 1998, 2003, 2008, 2013, and 2019. Adult individuals declaring healthcare utilization within 14 days before the interview scored healthcare quality, and resolubility was estimated through the proportion of visits required for solution of health issues. Information on implementation of PMAQ-AB in Brazilian municipalities was included in the dataset. Logistic models were estimated to identify associations between healthcare quality and resolubility, controlling for individual, household, healthcare funding source, and geographic characteristics.

Results: Results showed that the main healthcare provider was the public sector (Sistema Único de Saúde, SUS). Major part of individuals presented good evaluation of healthcare quality and high resolubility of their health issues; however, there was decrease in healthcare quality and resolubility throughout the period. Findings indicated significant association between healthcare quality and resolubility (OR=3.07; p<0.001), PMAQ implementation (OR=12.5; p<0.001), and certain personal characteristics of individuals, particularly private health insurance ownership (OR=1.33; p<0.001) and occurrence of multimorbidity (OR=0.71; p<0.001).

Conclusion: Adequate solution of health issues may contribute to tackle problems in healthcare provision, particularly ensuring community involvement and contributing to transcend challenges in patients’ engagement in the assessment of health system frailties. Yet, the lack of involvement of patients in horizon scanning to support further improvements in the health system, and the recent extinction of PMAQ-AB after successful implementation in the last decades show underappreciation of the perspective of patients in healthcare quality evaluation in Brazil.