The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador.

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

"Measuring the health and fiscal outcomes of solid waste management operations by intergovernmental arrangements: The case of public consortia in Brazil".

This study estimates the health-related and public expenditure impacts of the solid waste services provided by public consortia in Brazilian Municipalities from the enactment of Public Consortia law (2005) to 2019. To conduct the analysis, we applied the econometric method of staggered difference-in-differences to publicly available datasets at the municipality level. The results show that the operation of solid waste services by public consortia had statistically significant effects in reducing hospitalizations caused by Schistosomiasis, Diarrhea/gastroenteritis (up to 5 years age) and other intestinal diseases. The results also indicate a positive impact on the reduction of environmental expenses in treated municipalities, supporting the idea that a Solid Waste Consortium can serve as a local coordinator and improve health and fiscal indicators simultaneously. The findings provide quantitative evidence that policymakers at the local and regional level can use to better understand the benefits of adhering to public consortia when preparing new investments and operation developments for this sector. This paper contributes to the literature of applied research in solid waste by shedding light on the underexplored theme of the intergovernmental cooperative arrangements, which can be instrumental in accelerating and enhancing the development of solid waste services.

The effect of conflict-related violence intensity and alcohol use on mental health: The case of Colombia.

We investigated the causal impact of conflict-related violence on individual mental health and its potential pathways in Colombia. Using data from before and after the 2016 peace accord between the Colombian government and the Revolutionary Armed Forces of Colombia (FARC), we adopted a difference-in-differences empirical design combined with instrumental variables estimation. We also used formal mediation analysis to investigate a possible mediating role of alcohol consumption in the relationship between conflict exposure and mental health. Our results did not support the hypothesis that changes in exposure to conflict violence after the peace accord causally led to any changes in individual mental health. We were unable to identify a statistically significant mediating effect of alcohol consumption in the relationship between exposure to conflict violence and mental health.

Population well-being and the COVID-19 vaccination program in Chile: evidence from Google Trends.

OBJECTIVE: We analyze the dynamics of the mental well-being of the Chilean population in response to the progress of the vaccination strategy implemented by the government. STUDY DESIGN: This study aims at investigating the possibility of using Google Trends as an instrument for tracking mental well-being of the Chilean population. METHODS: We use the volume of searches for keywords in Google Trends (GT) related to Anguish, Anxiety, Depression, and Stress as a proxy for population well-being. Using event study methods, we analyze social attention reactions to news about the vaccination program. We implement a Difference-in-Difference-in-Differences estimation to estimate changes in population welfare by socio-economic status induced by the progress of inoculation. RESULTS: We show that social attention to mental health problems is sensitive to news about the vaccination program. Moreover, and most importantly, we find that mental well-being responds positively to the percentage of inoculated people. This phenomenon appear to be permanent and affected by socio-economic status, with the wealthier population experiencing greater improvements than the less wealthy. CONCLUSIONS: During the COVID-19 vaccination program in Chile, social attention to mental health problems appears to be sensitive to news about the vaccination program. There is also strong evidence of socio-economic status-induced heterogeneity in population responses to program implementation. The above phenomena appears to be permanent and cannot be attributed to either socio-economic segregation in access to vaccines or to the highly stratified schedule of the vaccination program.

The effects of a national policy to reduce c-sections in Brazil.

In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply-side component that prohibits elective c-sections before the 39th gestational week and a demand-side awareness component. Since the policy is not binding for cases with a strong medical c-section indication, we use births of breech- and transverse-positioned babies as a counterfactual for births of cephalic-positioned babies in a difference-in-differences framework. Our results reveal that the policy decreases the rate of c-sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first-minute APGAR scores. There is evidence that policy effectiveness is driven by its demand-side component.

A causal modelling framework for short-term effects of PM2.5 on hospitalisations: A nationwide time series study in Brazil.

Accurate estimates of the causal effect of air pollution on health outcomes, are critical when calculating attributable disease burdens. Brazil has a large population exposed to fast-growing emissions of air pollutants, however no national level studies have been conducted to examine the causal effect of PM2.5 exposure on health outcomes. This study proposes a novel approach, to accurately estimate the causal relationship between daily PM2.5 exposure and hospitalisations, across 1,814 Brazilian cities during 2000-2015. A variant of the difference-in-differences (DID) approach was applied under a counterfactual framework. Daily time series data were divided into panels. Seasonality and long-term trend were controlled using indicators for the panel. Variables which do not change within a short-period were controlled using a dummy variable for the day. Controls for variables which vary day by day, were included in the model. We found the proposed model exhibited competitive power performance in detecting causal associations between short-term PM2.5 exposure and hospitalisations in Brazil. A 10 µg/m3 increase in PM2.5 concentrations over four days (lag 0-3) was associated with a 1.06 % (95 % CI: 0.94 to 1.17) increase in all-cause hospitalisations and accounted for 1.26 % (95 % CI: 1.12-1.39) of total hospitalisations. Larger effects were found for children aged 0-4 years and the elderly aged 80+ years, suggesting policies should be developed to minimise the exposure of these age groups.

COVID-19 and the beef market in Latin America: An impact assessment by supply and demand.

The impact of COVID-19 on agricultural markets, especially the beef market, represents one of the greatest food security challenges the world is facing in the post-pandemic era and, for this reason, has been widely documented. This study contributes to the literature through a comprehensive impact analysis of the effects of COVID-19 on both the demand and supply of beef in Latin America and thus provides valuable information for two of the most important links of the beef value chain. Robust econometric methods and a graphic analysis were used that give solidity to the investigation. The analysis used a data panel of supply and demand variables between 2018 and 2022 derived from the US Department of Agriculture. The results suggest that the beef market was strongly affected by the pandemic related health emergency, presenting decreases in both consumption and production. These effects are transitory, however, since the analysis of the post-pandemic data revealed that consumption and production return to normal and seem to grow until smoothing out over time.

Impact Evaluation of An Interdisciplinary Educational Intervention to Health Professionals for the Treatment of Mild to Moderate Child Malnutrition in Mexico: A Difference-in-Differences Analysis.

The prevalence of undernutrition in Mexican children younger than 5 years old has been 14% since 2006. There are clinical practice guidelines for mild to moderate malnutrition in children in the Mexican health system; however, they are not applied. In addition, the knowledge and practices of health professionals (HP) to treat malnutrition in health centers are insufficient to perform adequate assessments and correct treatments. An impact evaluation of an interdisciplinary educational intervention was carried out on 78 HPs for the treatment of children with mild to moderate malnutrition of low resources, with 39 in the intervention group and 37 in the counterfactual group, estimated as the comparison group. A Food and Agriculture Organization (FAO)-validated questionnaire adapted to child malnutrition about knowledge, attitudes, and practices was applied before, after, and 2 months after a malnutrition workshop. The difference-in-differences analysis showed that the educational intervention group had a significant improvement in knowledge, attitudes, and practices before and after the intervention (grades of 54.6 to 79.2 respectively, p = 0.0001), compared with the comparison group (grades of 79.2 and 53.4, respectively, p = 0.0001), which was maintained over two months (grades of 71.8 versus 49.8, p = 0.0001, respectively). The multivariate analysis showed that the probability of improvement in learning by 30% was 95-fold higher in the educational intervention group versus the comparison group, OR = 95.1 (95% CI 14.9-603.0), and this factor was independent of sex, age, education, or hospital position. Despite the availability of clinical practice guidelines for the assessment and treatment for child malnutrition, education in malnutrition for HPs is effective and needed to achieve a significant improvement in children's health.

Health Promotion Programs Can Mitigate Public Spending on Hospitalizations for Stroke: An Econometric Analysis of the Health Gym Program in the State of Pernambuco, Brazil.

Health promotion programs can reduce morbidity and mortality from chronic diseases, as well as public spending on health. The current study aims to evaluate the effects of the Health Gym Program on expenditures on hospitalizations for stroke in the state of Pernambuco, Brazil. This public policy impact assessment used an econometric model that combines the difference-in-difference estimator with propensity score matching. Data referring to the health, demographic, and socioeconomic characteristics of the 185 municipalities in Pernambuco were collected for the period from 2007 to 2019. Validation tests were carried out of the empirical strategy, the estimation of models with fixed effects for multiple periods and validation post-tests, and robustness of the results. In total, US$ 52,141,798.71 was spent on hospitalizations for stroke, corresponding to 4.42% of the expenses on hospitalizations for all causes over the period studied. Municipalities that implemented the Health Gym Program spent 17.85% less on hospitalizations for stroke than municipalities that did not. The findings of this study indicate that the Health Gym Program was effective in reducing expenses with hospitalizations for stroke and that its implementation has the potential to reduce expenses related to rehabilitation, sick leave, and early retirement.

Loss of life expectancy from PM2.5 in Brazil: A national study from 2010 to 2018.

BACKGROUND: Long-term exposure to PM2.5 is proved to be linked with mortality. However, limited studies have estimated the PM2.5 related loss of life expectancy (LLE) and its changing trends. How much life expectancy would be improved if PM2.5 pollution is reduced to the new WHO air quality guideline (AQG) level is unclear. METHODS: Data on deaths from all-causes, cancer, cardiovascular and respiratory diseases were collected from 5,565 Brazilian municipalities during 2010-2018. A difference-in-differences approach with quasi-Poisson regression was applied to examine the PM2.5-years of life lost (YLL) associations and PM2.5 associated LLE. RESULTS: The annual PM2.5 concentration in each municipality from 2010 to 2018 was 7.7 µg/m3 in Brazil. Nationally, with each 10 µg/m3 increase in five-year-average (current and previous four years) concentrations of PM2.5, the relative risks (RRs) were 1.18 (95% CI: 1.15-1.21) for YLL from all-causes, 1.22 (1.16-1.28) from cancer, 1.12 (1.08-1.17) from cardiovascular and 1.17 (1.10-1.25) from respiratory diseases. Life expectancy could be improved by 1.09 (95% CI: 0.92-1.25) years by limiting PM2.5 concentration to the national lowest level (2.9 µg/m3), specifically, 0.20 (0.15-0.24) years for cancer, 0.16 (0.11-0.22) years for cardiovascular and 0.09 (0.05-0.13) years for respiratory diseases, with significant disparities across regions and municipalities. Life expectancy would be improved by 0.78 (0.66-0.90) years by setting the new WHO AQG PM2.5 concentration level of 5 µg/m3 as an acceptable threshold. CONCLUSIONS: Using nationwide death records in Brazil, we found that long-term exposure to PM2.5 was associated with reduced life expectancy from all-causes, cancer, cardiovascular and respiratory diseases with regional inequalities and different trends. PM2.5 pollution abatement to below the WHO AQG level would improve this loss of life expectancy in Brazil.

Associations between long-term exposure to PM2.5 and site-specific cancer mortality: A nationwide study in Brazil between 2010 and 2018.

Long-term exposure to PM2.5 has been linked to lung cancer incidence and mortality, but limited evidence existed for other cancers. This study aimed to assess the association between PM2.5 on cancer specific mortality. An ecological study based on the cancer mortality data collected from 5,565 Brazilian cities during 2010-2018 using a difference-in-differences approach with quasi-Poisson regression, was applied to examine PM2.5-cancer mortality associations. Globally gridded annual average surface PM2.5 concentration was extracted and linked with the residential municipality of participants in this study. Sex, age stratified and exposure-response estimations were also conducted. Totalling 1,768,668 adult cancer deaths records of about 208 million population living across 5,565 municipalities were included in this study. The average PM2.5 concentration was 7.63 µg/m3 (standard deviation 3.32) with range from 2.95 µg/m3 to 28.5 µg/m3. With each 10 µg/m3 increase in three-year-average (current year and previous two years) concentrations of PM2.5, the relative risks (RR) of cancer mortality were 1.16 (95% confidence interval [CI]: 1.11-1.20) for all-site cancers. The PM2.5 exposure was significantly associated with several cancer-specific mortalities including oral, nasopharynx, oesophagus, and stomach, colon rectum, liver, gallbladder, larynx, lung, bone, skin, female breast, cervix, prostate, brain and leukaemia. No safe level of PM2.5 exposure was observed in the exposure-response curve for all types of cancer. In conclusion, with nationwide cancer death records in Brazil, we found that long-term exposure to ambient PM2.5 increased risks of mortality for many cancer types. Even low level PM2.5 concentrations had significant impacts on cancer mortality.

Effect of an abrupt change in sexual and reproductive health policy on teen birth rates in Ecuador, 2008-2017.

Several countries have implemented "family-centered" abstinence-only policies for teenagers, as opposed to encouraging utilization and expansion of reproductive health services and education. Little is known, however, about the effects of these more restrictive policies on adolescent birth rates at the national level or their differential effects by race and ethnicity. The extant literature is even scarcer in low- and middle-income countries. We analyze an unexpected policy change in Ecuador that abruptly reversed course and restricted reproductive health services for teenage women in 2014. We use a canton- and time-fixed effects difference-in-differences analysis of Ecuador's 221 cantons with time-varying controls to analyze the impact of the abrupt policy change on the difference of teen (15-19 years) minus young adult (20-24 years) birth rates. In a difference-in-difference-in-differences analysis, the policy change increases birth rates by 8.5 births per 1000 women in cantons with higher indigenous concentration. Results are robust to changes in the comparison population (young adults vs. women in their late 20 s or in their early 30 s), pre-intervention control periods, population weighting, serial correlation, logarithmic model specification, adjustments for intervention year, definition of indigenous concentration, and potential delays in policy implementation.

Price impact of taxes on sugary drinks in Brazil.

Sugary drink consumption is an important contributor to the current global epidemic of obesity. In recent years, 50 countries or jurisdictions have implemented taxes on sugary drinks as an instrument to discourage consumption. Against the tide, Brazil reduced taxes on these beverages in 2017 and 2018. However, a recent debate - raised by the federal government - has started over taxation of sugary and alcoholic beverages (sin taxes). The effectiveness of this policy will depend on how the taxes are transferred to prices. In this sense, this paper we aim to quantify the impacts of the tax reduction on prices of sugary drinks in Brazil, and therefore to contribute to the debate by calculating the pass-through of taxes to prices of these products in the Brazilian context. We analyze the Brazilian market using a panel data of products, by brand, collected by Euromonitor from 2013 to 2018. Our results suggest that the transfer of taxes to prices depends on the firm size and the type of product, with pass-through rates ranging from 15% to 124%.

Evaluación del mecanismo de pago capitado en el seguro integral de salud del Perú / Assessment of the mechanism of payment capitated in the peruvian seguro integral de salud.

Objetivo: Evaluar el impacto del mecanismo de pago capitado, implementado por el Seguro Integral de Salud (SIS), en la ejecución de los recursos provenientes de la fuente de financiamiento donaciones y transferencias, durante los años 2012 al 2016, Perú. Métodos: Se evaluó los porcentajes de ejecución de las regiones, el número de prestaciones preventivas versus el número de prestaciones recuperativas y se midió el impacto en el incremento de las atenciones preventivas en las regiones piloto versus las regiones del contrafactual. Se realizó un estudio descriptivo retrospectivo pre post y diferencia de diferencias entre las regiones piloto Apurímac, Amazonas, Ayacucho, Callao y Huancavelica comparados con un contrafactual apareado por Índice de Desarrollo Humano; además, se consideró a las regiones de Moquegua, Loreto, Puno, Cajamarca y Huánuco. Resultados: Se observó un incremento del porcentaje promedio de ejecución, previo al mecanismo capitado, de 68,5% en el 2012 al 92,3% el 2016; asimismo, el incremento a nivel nacional de las prestaciones preventivas versus las prestaciones recuperativas, llegando invertirse el peso específico de las prestaciones preventivas a favor de las mismas y mediante el método de diferencias en diferencias se evidenció que las regiones piloto tuvieron una diferencia positiva de 1551 prestaciones preventivas por cada 10 000 asegurados sobre las regiones del contrafactual.

Objective:To Assess the impact of the capitated payment mechanism, implemented by the Comprehensive Health Insurance (SIS), in the execution of resources from the source of financing, donations and transfers, during the years 2012 to 2016, Peru. Methods: Assessment of the execution percentages of the regions, the number of preventive benefits versus the number of recuperative benefits and the impact on the increase of preventive care in the pilot regions versus the counterfactual regions was measured. A retrospective descriptive study was carried out pre post and difference of differences between the pilot regions Apurímac, Amazonas, Ayacucho, Callao and Huancavelica compared with a counterfactual paired by the Human Development Index; In addition, the regions of Moquegua, Loreto, Puno, Cajamarca and Huánuco were considered. Results: An increase in the average percentage of execution was observed, prior to the capitated mechanism, from 68,5% in 2012 to 92,3% in 2016; likewise, the increase at the national level of preventive benefits versus recuperative benefits, with the specific weight of preventive benefits being invested in favor of them and, using the difference in differences method, it was evident that the pilot regions had a positive difference of 1551 preventive benefits for every 10,000 insured persons versus the counterfactual regions.

Assessing the impact of the mais médicos program on basic health care indicators

The Mais Médico Program was launched by the federal government in 2013 with the main objective of reducing the shortage of physicians in regions of socioeconomic vulnerability in Brazil. Since then, the program has been attracting interest in evaluating its effectiveness on the localities adhered. This paper aims to measure the effects generated by the “Mais Médicos” Program on health indicators of Brazilian municipalities from an econometric approach of policy evaluation. Using a difference-in-differences methodology, the effects on indicators of basic health care, morbidity and mortality were analyzed from the Program data between 2013 and 2015. There are evidences that the “Mais Médicos” Program has positive effects on the primary healthcare indicators, particularly on appointments, consultations, referrals, examinations, and home visits, and negative effects over some indicators of morbidity. However, the Program does not seem to have been able to reduce mortality in the municipalities.

O Programa Mais Médicos: uma avaliação do impacto sobre indicadores de saúde do Brasil

A escassez de médicos e os desequilíbrios geográficos destes profissionais são problemas em sistemas de saúde de diversos países. Em 2013, no Brasil, verificava-se uma razão de dois médicos por mil habitantes e uma distribuição desigual destes nas regiões do país. Para reverter este cenário, foi instituído o Programa Mais Médicos para o Brasil, estruturado em três eixos: o provimento emergencial de profissionais médicos denominado de Projeto Mais Médicos (PMM); o investimento na Rede de Serviços Básicos de Saúde; e o desenvolvimento da formação médica no Brasil. A presente tese busca analisar o impacto do PMM para o Brasil na atenção básica da saúde...

The shortage of physicians and the geographical imbalances of these professionals are problems in health systems in different countries. In 2013, in Brazil, there was a ratio of two physicians per thousand inhabitants and an unequal distribution of these in the regions of the country. To reverse this scenario, the Medical Doctors Program for Brazil was established, structured in three axes: the emergency provision of medical professionals called the More Medical Project (PMM); the investment in the Network of Basic Health Services; and the development of medical training in Brazil. The present thesis aims to analyze the impact of the PMM for Brazil on basic halth care...

Evaluating the impact of contracting out basic health care services in the state of São Paulo, Brazil.

As a means of dealing with shortcomings in the coverage, quality and efficiency of the public health care sector, several municipalities in the state of São Paulo, Brazil, have started to contract pre-certified non-profit or non-governmental organizations to take part in the delivery of health care services.This paper explores the impact of introducing these contracts in the primary health care sector. Using data on the 645 municipalities in the state of São Paulo and difference-in-differences methods, we estimate the effect of contracting out in the primary health care sector on various dimensions of mortality and health care use. The results show that implementation of the contracting out strategy significantly increases the number of primary health care appointments by approximately one appointment per user of the national health care system per year. Point estimates indicate a reducing effect on hospitalization for preventable diseases.

Conditional cash transfers and the double burden of malnutrition among children in Colombia: a quasi-experimental study.

Conditional cash-transfer (CCT) programmes have been shown to improve the nutritional and health status of children from poor families. However, CCT programmes may have unintended and not fully known consequences by increasing the risk of overweight and obesity. We examined the impact of Familias en Acción (FA), a large CCT programme in Colombia, on the double burden of malnutrition among pre-school and school-aged children. Height and weight were measured before programme enrolment and during follow-ups in 1290 children from thirty-one treatment municipalities, being compared with 1584 children from sixty-two matched control municipalities. We used a difference-in-differences approach to evaluate the effect of FA on children's stunting, BMI z-scores, thinness, overweight and obesity, controlling for individual and municipality-level confounders. At baseline, the prevalences of stunting and overweight were 30·3 and 15·4 %, respectively, in treatment municipalities and 27·9 and 17·4 % in control municipalities. FA was associated with reduced odds of thinness (OR 0·26; 95 % CI 0·09, 0·75) and higher BMI-for-age z-scores (BMI z-scores) (ß 0·14; 95 % CI 0·00, 0·27; P<0·05), although the latter was of small clinical significance. The prevalence of stunting, overweight and obesity decreased over time, but the effect of FA on these outcomes was not significant. The CCT programme in Colombia reduced the odds of thinness, but had no effect on stunting, a more prevalent outcome. The FA programme had no effect on overweight or obesity, although BMI z-scores were higher for children under treatment, raising the possibility of an increase of small clinical significance on BMI among pre-school and school-aged children.

Efeito das Unidades de Pronto Atendimento (UPA) na mortalidade por infarto agudo no miocárdio nas capitais e regiões metropolitanas do Brasil / Effect of Emergency Care Units (PMU) on mortality due to acute myocardial infarction in the capitals and metropolitan regions of Brazil

As Unidades de Pronto Atendimento (UPAs) são estabelecimentos de saúde integrados ao Sistema Único de Saúde (SUS) que foram implantados em vários municípios do país, a partir da publicação da Portaria GM/MS nº 2.922/2008, para fortalecer a Política Nacional de Atenção às Urgências. As UPAs tem o objetivo de prestar atendimento resolutivo de urgência e emergência aos pacientes acometidos por quadros agudos de natureza clínica e realizar o primeiro atendimento aos casos de natureza cirúrgica, estabilizando-os. Diante da relevância do assunto, este estudo analisa o impacto das UPAs sobre a taxa de morte por Infarto Agudo de Miocárdio (IAM) nas capitais e regiões metropolitanas do Brasil, já que esta doença faz parte do rol da assistência prestada por estas unidades. Com a finalidade de tratar a endogeneidade do modelo econométrico, a estratégia de identificação adotada utiliza o método de Diferenças em Diferenças (DD), com dados municipais em painel para o período entre 2001 a 2012. Os resultados mostram que há impacto positivo e estatisticamente significativo da política, a qual apresentou uma redução na taxa de mortalidade por Infarto Agudo do Miocárdio e que, ao aumentar uma unidade de UPA, a taxa de morte cai 0,81, em média, bem como, foi observado no modelo completo com dummies de tratamento que as unidades observacionais com mais de 3 UPAs oferecem uma redução de 3,71 pontos na taxa de mortalidade por infarto. Também foram realizados testes de robustez utilizando taxas de morte de outras patologias não correlacionadas com o tratamento, assegurando o efeito da política.(AU)

The Emergency Care Units (UPA 24h) are health facilities integrated into the Unified Health System (SUS) which were implemented in several municipalities since the publication of the Ordinance GM/MS nº. 2.922/2008 to strengthen Policy national Attention to Emergencies. The UPA aims to provide health care resolving urgent and emergency cases in patients who suffering from acute episodes of clinical nature and conduct the first care of patients with surgical nature, stabilizing them. Given the importance of the subject, this study analyzes the impact of UPAs on the death's rate from Acute Myocardial (IAM) in capital cities and metropolitan areas from Brazil, as this disease is part of the donor list provided by these units. In order to treat endogeneity problem, the identification strategy adopted is the differences-in-differences, with a panel data from 2001 to 2012. The results show a positive and statistically significant impact of the policy, which showed on lowering the rate of deaths from acute myocardial infarction and that by increasing one UPA unit, the death rate falls 0.81 on average well as it noted in the complete model with dummies treatment that observational units over 3 PSUs proffer a reduction of 3.71 points in the infarction mortality rate. Robustness tests too were conducted using rates of death from other pathologies not related to treatment, ensuring the effect of the policy.(AU)