Mobile emergency care system and population health: a study of SAMU-192 in Brazil

• Ano de defesa: 2024
• Autor(a) principal: Battisti, Jolanda Eline Ygosse
• Orientador(a): Rocha, Rudi
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Palavras-chave em Português: Avaliação de política de saúde; Sistema móvel de atendimento de emergência; SAMU-192; Taxas de mortalidade; Desigualdades em saúde; Fluxos de pacientes; Mobilidade
• Palavras-chave em Inglês: Health policy evaluation; Mobile emergency-care system; Mortality rates; Health inequalities; Patient flows, mobility
• Link de acesso: https://hdl.handle.net/10438/34984

This thesis evaluates the impact of the implementation and gradual expansion of Brazil’s mobile emergency-care service on population health outcomes and on patient mobility. SAMU-192 was regulated by the National Policy on Emergency Care in 2003 and implemented as of 2004, both in terms of access and distribution of the service. The government adopted this program to combat untimely deaths due to accidents and violence, as well as clinical emergencies (e.g., heart attacks, strokes). The thesis uses the difference-in-differences approach from Callaway & Sant’Anna (2021) that allows for staggered treatment and heterogeneous time and group effects, to investigate the program’s effects on mortality rates. The study shows a statistically significant causal impact of the SAMU-192 program on overall mortality rates, for all causes as well as medical causes, but not for external causes. The adoption of a mobile emergency care system has resulted, on average in a fall of untimely deaths of 5.7% relative to the population-weighted baseline mortality rate. This impact is persistent. I also investigate displacement effects and test for gender, race, demographic and socioeconomic heterogeneity. The results on mobility show that SAMU-192 increases patient outflows from their municipalities of residence to be hospitalized in other municipalities by 3.9%.