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What happens to population health when the doctors leave? Evidence from the exit of Cuban doctors in Brazil

Stefan Sliwa Ruiz1, Malte Becker2, Thomas Hone3

  • 1Bernhard Nocht Institute for Tropical Medicine, Germany.

Journal of Health Economics
|January 9, 2026
PubMed

Insights

A large exit of Cuban doctors in Brazil reduced chronic disease care but did not impact overall population health outcomes. Health system adaptations and service shifts mitigated adverse effects on health.

Area of Science:

  • Health Economics
  • Public Health Policy
  • Medical Workforce Studies

Background:

  • The More Doctors Program in Brazil aimed to address physician shortages, particularly in underserved areas.
  • Understanding the impact of sudden physician departures is crucial for health system resilience.

Purpose of the Study:

  • To analyze the effects of a large-scale exit of Cuban doctors on population health outcomes in Brazil.
  • To examine health system adaptation, including inputs, outputs, and service utilization.

Main Methods:

  • Utilized the exogenous timing of Cuban doctor departures from the More Doctors Program for identification.
  • Compared municipalities with higher versus lower reliance on Cuban physicians.
  • Analyzed changes in service utilization and population health outcomes.

Main Results:

  • Observed persistent reductions in the management of chronic diseases.
  • Service utilization for acute conditions, such as maternal care and infections, showed rapid recovery.
  • No significant changes in population health outcomes were detected despite utilization shifts.

Conclusions:

  • Health system adaptations, including supply-side responses and demand diversion, effectively mitigated widespread negative health impacts.
  • The Brazilian health system demonstrated resilience in adapting to significant physician workforce changes.

Keywords:
Doctor supplyHealth outcomesHealthcare utilization

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