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10.1371/journal.pone.0241017

http://scihub22266oqcxt.onion/10.1371/journal.pone.0241017
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33104705!7588110!33104705
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suck abstract from ncbi


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pmid33104705      PLoS+One 2020 ; 15 (10): e0241017
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  • How the plates of a health system can shift, change and adjust during economic recessions: A qualitative interview study of public and private health providers in Brazil s Sao Paulo and Maranhao states #MMPMID33104705
  • Russo G; Levi ML; Seabra Soares de Britto E Alves MT; Carneiro Alves de Oliveira BL; de Souza Britto Ferreira de Carvalho RH; Andrietta LS; Filippon JG; Scheffer MC
  • PLoS One 2020[]; 15 (10): e0241017 PMID33104705show ga
  • BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (Sao Paulo) and impoverished (Maranhao) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in Sao Paulo and Maranhao. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhao. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.
  • |*Betacoronavirus[MESH]
  • |*Coronavirus Infections[MESH]
  • |*Economic Recession[MESH]
  • |*Pandemics[MESH]
  • |*Pneumonia, Viral[MESH]
  • |Administrative Personnel/*psychology[MESH]
  • |Ambulatory Care Facilities/economics[MESH]
  • |Attitude of Health Personnel[MESH]
  • |Brazil[MESH]
  • |COVID-19[MESH]
  • |Community Health Services/economics[MESH]
  • |Developing Countries[MESH]
  • |Health Care Sector/*economics[MESH]
  • |Health Facility Administrators/*psychology[MESH]
  • |Health Personnel/*psychology[MESH]
  • |Humans[MESH]
  • |Insurance, Health, Reimbursement[MESH]
  • |Interviews as Topic[MESH]
  • |Physicians/psychology[MESH]
  • |Private Sector/*economics[MESH]
  • |Public Sector/*economics[MESH]
  • |Qualitative Research[MESH]
  • |SARS-CoV-2[MESH]
  • |Telemedicine[MESH]


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