Does Universalization of Health Work? Evidence from Health Systems Restructuring and Maternal and Child Health in Brazil

Investigators: CDEP Affiliate Rodrigo Soares

This project investigates a major restructuring of the health system in Brazil which was implemented as a way to operationalize the universalization of access to public health services. There was a massive expansion of primary health facilities with GPs and outreach workers at the community level, alongside a decline in the density of hospital facilities and specialists per capita. We consolidate administrative data from several sources to obtain information on program implementation, local level health facilities, indicators of access including hospitalization, and births and deaths by cause and age. Using an event study approach, we identify large reductions in maternal, fetal, neonatal and post-neonatal mortality alongside increases in the intensity of prenatal care and reductions in fertility. We also document increases in the probability of a hospital birth and increases in maternal hospitalization, which suggest that the mortality reductions were driven by increased access. There is no significant improvement in the quality of births, which may be because of fetal survival selection and a shift in the composition of births in favor of births to less educated women. We also show that the impact of the changes in the system was larger among less educated women, but also larger in municipalities with better pre-existing health infrastructure at higher levels (hospitals).

Published as "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," Documentos de Trabajo LACEA 017122, The Latin American and Caribbean Economic Association, 2019.

This project is part of CDEP's Human Capital Initiative.