Pay-for-performance for primary health care in Brazil: A comparison with England's Quality Outcomes Framework and lessons for the future.

Pay-for-performance (P4P) has been widely applied in OECD countries to improve the quality of both primary and secondary care, and is increasingly being implemented in low- and middle-income countries. In 2011, Brazil introduced one of the largest P4P schemes in the world, the National Programme for Improving Primary Care Access and Quality (PMAQ). We critically assess the design of PMAQ, drawing on a comparison with England's quality and outcome framework which, like PMAQ, was implemented at scale relatively rapidly within a nationalised health system.

[How Brazilians access Primary Health Care: evolution and adversities in recent times (2012-2018)].

The scope of this study is to analyze access to primary care in Brazil between 2012 and 2018, taking into consideration the availability of services and the physical-structural, temporal and organizational characteristics of the primary care units and teams, highlighting the main advances and obstacles to their enhancement in different contexts. It involved a descriptive cross-sectional and longitudinal study, with a quantitative approach based on secondary data from the National Program for the Improvement of Access and Quality of PC and population coverage data from the Ministry of Health. A total of 15,378 teams were selected and data screened from 59,354 users relating to the teams selected for 2012, and 56,369 users for 2018.

Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018.

Background: Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world.

Integrality and comprehensiveness of service provision in Primary Health Care in Brazil (2012-2018).

Objectives: to analyze comprehensiveness elements in Primary Care in Brazil, between 2012 and 2018, considering preventive and assistance aspects, pointing out advances and obstacles to its improvement in different contexts.

Methods: a retrospective longitudinal study using data from the Brazilian National Program for Improving Access and Quality in Primary Care. 15,378 teams were selected that participated in both 1st and 3rd cycles of the program.

[National primary health care policy in Brazil: an analysis of the review process (2015-2017)Política Nacional de Atención Básica en Brasil: un análisis del proceso de revisión (2015-2017)].

Objective: To describe and discuss events associated with the latest review of the national primary health care (PHC) policy in Brazil (, PNAB) so as to highlight narratives that may contribute to future analyses focusing on the formulation, implementation, and assessment of this policy.

Method: Participant observation report of the PNAB review process, based on content and document analyses.

Results: The review process of PNAB, which took place between 2015 and 2017, was strongly marked by technical and political dispute among the Ministry of Health and authorities representing municipal and state health departments.