Family Health Strategy coverage and hospitalizations for primary care-sensitive conditions: evidence from municipalities in the state of Rio de Janeiro between 2008 and 2020

Abstract

Introduction: The Family Health Strategy (FHS) is the main model of Primary Health Care organization in Brazil. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are used as an indicator of primary care effectiveness. Objective: To evaluate the association between FHS coverage and ACSCs in municipalities of the state of Rio de Janeiro, Brazil, from 2008 to 2020. Material and Methods: A longitudinal ecological study was conducted using panel data from 92 municipalities. Data were obtained from SIH/SUS, PROADESS, and IBGE. The association between FHS coverage and the ACSC rate per 100,000 inhabitants was estimated using fixed-effects models with robust standard errors clustered by municipality. Contemporary specifications, lags of up to three years, and year fixed effects were evaluated. Results and Discussion: A total of 1,196 observations were analyzed. The mean ACSC rate was 939.4 per 100,000 inhabitants, and mean FHS coverage was 73.1%. A negative association was observed in the contemporary model (β = −2.38; p < 0.10), with greater magnitude in the one-year lagged specification (β = −3.92; p < 0.05). The association lost significance with longer lags and after inclusion of year fixed effects. The disaggregated analysis showed reductions in most ACSC components and heterogeneity across municipalities. Conclusion: Higher FHS coverage was associated with lower ACSC rates, particularly with a one-year lag. However, the loss of significance after temporal adjustment and municipal heterogeneity indicate that this relationship should be interpreted cautiously.