Does Universalization of Healthwork? Evidence from Health Systems Restructuring and Expansion in Brazil

69 Pages Posted: 21 May 2019

See all articles by Sonia R. Bhalotra

Sonia R. Bhalotra

IZA Institute of Labor Economics

Rudi Rocha

Universidade Federal do Rio de Janeiro (UFRJ)

Rodrigo R. Soares

Columbia University - School of International & Public Affairs (SIPA); Getulio Vargas Foundation (FGV) - Sao Paulo School of Economics; IZA Institute of Labor Economics

Abstract

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

Keywords: universal health coverage, health systems, primary care, maternal mortality, infant mortality, birth outcomes

JEL Classification: I12, I18, J10, J13, J24, O54

Suggested Citation

Bhalotra, Sonia R. and Rocha, Rudi and Soares, Rodrigo R., Does Universalization of Healthwork? Evidence from Health Systems Restructuring and Expansion in Brazil. IZA Discussion Paper No. 12111. Available at SSRN: https://ssrn.com/abstract=3390099

Sonia R. Bhalotra (Contact Author)

IZA Institute of Labor Economics ( email )

P.O. Box 7240
Bonn, D-53072
Germany

Rudi Rocha

Universidade Federal do Rio de Janeiro (UFRJ) ( email )

Av. Pedro Calmon, 550
Cidade Universitária
Rio de Janeiro - RJ, 21941-901
Brazil

Rodrigo R. Soares

Columbia University - School of International & Public Affairs (SIPA) ( email )

420 West 118th Street
New York, NY 10027
United States

Getulio Vargas Foundation (FGV) - Sao Paulo School of Economics ( email )

Rua Itapeva 474 s.1202
São Paulo, São Paulo 01332-000
Brazil

IZA Institute of Labor Economics

P.O. Box 7240
Bonn, D-53072
Germany

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