Política de atenção domiciliar no Brasil: análises espacial, de cobertura, focalização e impacto do programa melhor em casa

Abstract

The home care policy in Brazil, represented by the Programa Melhor em Casa (PMeC), aims to promote in-home healthcare for patients with complex needs, thereby reducing hospital length of stay. This thesis evaluates the effectiveness of the PMeC on hospital length of stay between 2009 and 2024, employing a methodological approach that separates spatial analysis from impact assessment. For the spatial dimension, the Spatial Durbin Model (SDM) was applied to identify regional spillover effects, revealing a reduction in average hospital stays in municipalities neighboring those that implemented the program. Subsequently, the impact evaluation utilized the staggered difference-in-differences estimator proposed by Callaway and Sant’Anna (2021), allowing for the estimation of dynamic and time-varying policy effects. The findings indicate an average reduction of 4.45% in hospital stays among participating municipalities, intensifying to up to 17.71% after 13 years of implementation. The targeting and coverage analysis revealed that the PMeC prioritized municipalities with a higher proportion of elderly residents and well- stablished coverage of the Family Health Strategy (ESF), although territorial inequalities persist, characterized by low adoption in smaller municipalities and concentration in large urban centers. The results suggest that the PMeC constitutes a effective policy, whose effectiveness depends on institutional maturation and integration with primary care services.