Author:
Coube Maíra,Nikoloski Zlatko,Mrejen Matías,Mossialos Elias
Abstract
Abstract
Background
One of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no comprehensive and up-to-date studies focused on inequalities in both curative and preventive health care services utilisation.
Methods
We evaluated data from the National Household Sample Survey and the Brazilian National Health Survey, which are two nationally representative studies that include findings from 1998, 2003, and 2008 and 2013 and 2019, respectively. We calculated Erreygers-corrected Concentration Indices (CInds) to evaluate the magnitude of socioeconomic-related inequalities associated with five indicators of health care services utilisation, including physician visits, hospital admissions, surgical procedures, Pap smears, and mammograms. The main factors associated with these inequalities were identified via a decomposition analysis of the calculated CInds.
Results
While the results of our analysis revealed persistent inequalities in health care services utilisation that favour the wealthy, we found that the overall magnitude of these inequalities decreased over time. The largest inequalities were observed in the utilisation of preventive care services (Pap smears and mammograms) and services available in the poorest regions of the country. Except for admissions for labour and delivery, our findings revealed that wealthier individuals were more likely to utilise hospital services; this represents a change from findings reported in previous years. Private health insurance coverage and individual socioeconomic status are significantly associated with inequalities in health care services utilisation throughout Brazil.
Conclusions
Collectively, our findings suggest that we must continue to monitor potential inequalities in health care service utilisation to determine whether Brazilian policy objectives focused on improved health outcomes for all will ultimately be achieved.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Health Policy
Reference59 articles.
1. United Nations. Transforming our world: the 2030 agenda for sustainable development. 70th Session of the United Nations General Assembly, 21 October 2015; New York: UN; 2019. Available from: http://www.un.org/en/ga/search/view_doc.asp?symbol=A/ RES/70/1 Accessed 20 April 2022.
2. Organization for Economic Cooperation and Development. Unmet needs for health care: comparing approaches and results from international surveys. Paris: OECD; 2020. Available from https://www.oecd.org/health/health-systems/Unmet-Needs-for-Health-Care-Brief-2020.pdf. Accessed 20 June 2022.
3. Devaux M. Income-related inequalities and inequities in health care services utilisationation in 18 selected OECD countries. Eur J Health Econ. 2015;16(1):21–33.
4. Cite Mossialos, E, Dixon, A. Funding health care in Europe: weighing up the options. In: Mossialos E, Dixon A, Figueras J, Kutzin J, editors. Funding Health Care: Options for Europe. Buckingham. London: Open University Press; 2002.
5. Cookson R, Propper C, Asaria M, Raine R. Socio-economic inequalities in health Care in England. Fisc Stud. 2016;37(3–4):371–403.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献