Salário de médicos da APS e a tipologia rural-urbano dos municípios e sua relação com o contexto social e de saúde

Abstract

In ecological studies the unit of study is a geographical area or group of people and not individuals. This type of study is useful for testing plausibility or generating new hypotheses. This dissertation presents two different ecological studies that considered the municipal context as a unit of analysis. i) The first study aimed to identify possible municipal contextual factors that could influence the physician’s salaries in the Family Health Strategy (FHS) and was conducted among 78 municipalities in the North region, Minas Gerais, Brazil. The dependent variable referred to the amount paid to physicians contracted by the FHS. 22 contextual independent variables were considered, collected from official databases and distributed in 3 thematic blocks: geographic location, sociodemographic context and health and care indicators. Descriptive, bivariate and Multiple Linear Regression analyzes were conducted. After adjusting the model, the Distance to the Regional Center variable remained positively associated with the outcome (R2 = 6.4%). The results showed that the physician’s salary was not determined by measurable contextual municipal characteristics. There was a need to establish clear parameters for defining the salary value of doctors hired to work in the FHS. ii) The second study aimed to evaluate social and health indicators of the 853 municipalities in the state of Minas Gerais according to the rural-urban typology. 15 contextual variables were considered, distributed in 4 thematic blocks: rural-urban typology, geographical location, social indicators and health indicators. Descriptive and bivariate analyzes were conducted. There was a higher average of the Municipal Human Development Index (MHDI) among urban municipalities and a higher average of ESF coverage among rural municipalities. The municipalities classified in the rural typology, in general, presented better assistance results than the urban ones for the evaluated indicators. The results may be related to a higher average FHS coverage among rural municipalities. Finally, the results of the studies allow us to consider that the municipal context had little effect on doctors' salaries, except in relation to the distance to the regional center. In general, rural municipal contexts showed better health indicators when compared to urban ones.