Background:
Since 2011, the Brazilian city of Belo Horizonte has been operating an innovative scheme to support care-dependent older people in disadvantaged communities: Programa Maior Cuidado (PMC – Older Person’s Care Programme). This paper examines two potential effects of inclusion in PMC on types of outpatient health service utilisation by dependent older people. The first is that being in PMC is associated with a higher frequency of outpatient visits for physical rehabilitation. The second is that being in PMC is associated with a higher frequency of planned versus unplanned outpatient visits.
Methods:
We apply a quasi-experimental design to a unique set of government data. First, we preprocess our sample through different matching techniques such as ‘coarsened exact matching’ (CEM), ‘nearest neighbour’ based on logit scores (NN), ‘optimal pair’ (OP) and ‘optimal full’ (OF) methods. Second, we estimate marginal effects of being in PMC on our outcomes of interest. We use univariate log-binomial regressions with robust standard errors to calculate the incidence ratio of PMC on rehabilitation and planned visits.
Results:
We find significant positive incidence rates for belonging to PMC for both outcomes of interest under all matching specifications. The CEM shows a higher incidence rate for the proportion of visits for rehabilitation by PMC patients compared to the non-PMC controls: 3.35 (95% CI 1.79 - 6.27). For planned visits, there are significant positive associations for being in PMC in the CEM (1.25 (95% CI 1.17 - 1.33)) and the other models.
Conclusions:
Our analysis reveals significant positive associations between older people included in PMC and a matched set of controls for making outpatient visits that were planned, rather than unplanned. We find similar associations for the proportion of visits made for rehabilitation, as opposed to another reason. These findings indicate that PMC influences some elements of outpatient health service utilization by dependent older people.