Impact evaluation of the Brazilian Integrated Border Health System

IMPACT

This article presents a methodological framework that can be used to evaluate interventions in border regions. The case study was SIS-Fronteiras: a Brazilian project to support municipalities providing healthcare for economic migrants from neighbouring countries. This article uncovers important opportunities and challenges during the implementation of this project. The project failed partly because of inadequate management of resources. Future policies in regions with significant trans-border flows (for example between the USA and Mexico in North America; and across some European and Asian borders) should incorporate mechanisms of cross-border governance, co-operation and co-financing to increase the chances of success.

ABSTRACT

This study evaluates Brazil’s Integrated Border Health System (SIS-Fronteiras). First, propensity score matching and difference in differences techniques were applied to analyse the health indicators of the 588 municipalities in the border strip of Brazil. Second, the authors conducted and analysed 23 interviews and 12 focus groups. The results suggest that the inadequacy of the governance model explains the failure to improve healthcare conditions in these areas. This article contributes to deepening our understanding of public policies and, in particular, public health interventions in border regions.

KEYWORDS:

• Borders
• Brazil
• healthcare project
• impact evaluation
• medical tourism
• migration
• public policies
• SIS-Fronteiras
• trans-border population

Acknowledgements

This work was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Caroline Krüger

Caroline Krüger is a postdoctoral fellow at the School of Economics, Business Administration and Accounting at Ribeirão Preto/University of São Paulo. Her research interests include public policy evaluation, cross-border governance and sustainable development.

Marlon Fernandes Rodrigues Alves

Marlon Fernandes Rodrigues Alves is assistant professor of Strategy and Organizations at the SKEMA Business School, Université Côte d'Azur (GREDEG). His research interests lie in the microfoundations of strategy, innovation, and organizational learning.

Clarisse Mendes Pinto Gomes Ferreira

Clarisse Mendes Pinto Gomes Ferreira is a supervisor at the Brazilian National Regulatory Agency. Her main research area is public health policy.

Luiz Guilherme Dácar da Silva Scorzafave

Luiz Guilherme Dácar da Silva Scorzafave is associate professor of Economics at the School of Economics, Business Administration and Accounting at Ribeirão Preto/University of São Paulo. His research interests include impact evaluation, microeconometrics, public policies and social economics (labor, health, education and crime).

Cláudia Souza Passador

Cláudia Souza Passador is associate professor of Public Management at the School of Economics, Business Administration and Accounting at Ribeirão Preto/University of São Paulo. Her research interests include public management and public policy evaluation.

Adriana Cristina Ferreira Caldana

Adriana Cristina Ferreira Caldana is associate professor of Human Resources at the School of Economics, Business Administration and Accounting at Ribeirão Preto/University of São Paulo. Her research interests include sustainable human resource management, corporate social responsibility and responsible management education.