Gastos catastróficos em saúde e multimorbidade entre adultos mais velhos no Brasil

Abstract

OBJETIVO: Estimar a relação entre gasto catastrófico em saúde (GCS) e multimorbidade em amostra nacional representativa da população brasileira com 50 anos de idade ou mais. MÉTODOS: Foram utilizados dados de 8.347 participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (2015–2016). A variável dependente foi o GCS, definido pela razão entre as despesas com saúde do adulto de 50 anos ou mais e a renda domiciliar. A variável de interesse foi a multimorbidade (duas ou mais doenças crônicas), e a variável utilizada para estratificação foi o escore de riqueza. As principais análises foram baseadas na regressão logística multivariada. RESULTADOS: A prevalência de GCS foi de 17,9% e 7,5% para gastos correspondentes a 10% e 25% da renda domiciliar, respectivamente. A prevalência da multimorbidade foi de 63,2%. A multimorbidade apresentou associações positivas e independentes com GCS (OR = 1,95, IC95% 1,67–2,28 e OR = 1,40, IC95% 1,11–1,76 para gastos correspondentes a 10% e 25%, respectivamente). Os gastos associados à multimorbidade foram maiores entre aqueles com menor escore de riqueza. CONCLUSÕES: Os resultados chamam atenção para a necessidade de uma abordagem integrada da multimorbidade nos serviços de saúde, de forma a evitar os GCS, particularmente entre adultos mais velhos com piores condições socioeconômicas.

Measuring Financial Protection in Health in Brazil: Catastrophic and Poverty Impacts of Health Care Payments Using the Latest National Household Consumption Survey

“…However, this study had a much smaller sample, with only 4,850 observations. Bernardes et al 11 use a different database, the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI-Brasil) of 2015-2016, a survey with a sample of 9,412 individuals living in households that have at least one individual over the age of 50. They estimate that 17.9% of the households spend over 10% of their budget in health expenses, while 7.5% spend over 25%.…”

“…9,b Previous evidence in Brazil shows a wide range of estimates of catastrophic OOP health expenditure (from 0.7% to 21.0%) but these used different methodologies, including surveys with smaller sample (Luiza etal. 4 ), or sample that is specific to households with older individuals, 11 or older databases. 12,13 This paper uses the latest Brazilian Consumer Expenditure Survey (Pesquisa de Orçamento Familiar or POF), released in 2020 with data from 2017/2018, to analyze the composition of household spending on health care and the effects of OOP on financial protection within the Brazilian health system.…”

Discontinuation of Health Interventions Among Brazilian Older Adults During the Covid-19 Pandemic: REMOBILIZE Study

“…37 Although most Brazilian older adults count on income from pensions and retirement (73.6%), researchers found that an even more significant decline in income for this group (22.0%) 37 could be explained by the reduction in non-essential work activities during the pandemic period. 38 It was possible to observe a gradient effect between higher income and lower chance of discontinued health care, highlighting that income inequality influences health care adherence.…”

“…37 However, older adults with lower incomes have a 30% higher chance of having catastrophic expenditures (ratio between disbursement for health and total household income) than those with higher income. 38…”

“…37 However, older adults with lower incomes have a 30% higher chance of having catastrophic expenditures (ratio between disbursement for health and total household income) than those with higher income. 38 In 2020, with the COVID-19 pandemic, there was an 18% loss in the income generated by work in the Brazilian population. 37 Although most Brazilian older adults count on income from pensions and retirement (73.6%), researchers found that an even more significant decline in income for this group (22.0%) 37 could be explained by the reduction in non-essential work activities during the pandemic period.…”