Mudanças no padrão de utilização de serviços de saúde no Brasil entre 2013 e 2019

Abstract

Resumo Este estudo teve o objetivo de comparar os padrões de utilização de serviços de saúde, a partir das informações das edições da Pesquisa Nacional de Saúde (PNS), 2013 e 2019. Os dois desfechos “Procura de atendimento relacionado à saúde nas últimas duas semanas” e “Consulta médica nos últimos doze meses” foram analisados segundo fatores socioeconômicos, geográficos, e condições de saúde. Foram usados modelos multivariados de regressão de Poisson para investigar os fatores associados à procura de atendimento de acordo com o motivo (problema de saúde ou prevenção). Entre 2013 e 2019, a prevalência de doenças crônicas aumentou de 15,0% a 22,5%. A proporção de busca de atendimento cresceu de 15,3 a 18,6%, e de uso de médico, de 71,2% a 76,2%, com amplitudes de variação de 61,4-75,8% e 68,0-80,6% entre as regiões Norte e Sudeste. Para atendimento por problema de saúde, não houve associação significativa com rendimento per capita, após o controle das demais covariáveis. Conclui-se que apesar da expansão da cobertura de utilização de serviços de saúde, as persistentes desigualdades regionais indicam necessidades de saúde não atendidas entre os residentes das regiões menos desenvolvidas. Modelos de atenção focados na prevenção e promoção da saúde são necessários.

Dual Use of Public and Private Health Care Services in Brazil

“…Our sample showed that women seek care more often than men. This is consistent with other studies in Brazil [30,32,35]. Reasons for women seeking care more often than men can be related to stronger preventive messages targeting women, which can be linked to the medicalization of the female body [49].…”

“…In our sample, persons aged 75 years or older had a 1.49 times higher chance of dual use of healthcare than the reference group. Past research on the demographic traits associated with healthcare use has shown age as an important factor, with the lowest and the highest age groups being associated with more frequent use of healthcare [32]. This is probably due to the higher health needs in both extremes of life.…”

“…Rural dwellings had higher odds of dual use. Many past studies have shown the persistent regional inequalities in Brazil, as well as inequalities between rural and urban settlements [29,32,51]. These span from economic and health inequalities between regions [28] to unequal development of the healthcare system and distribution of medical facilities among the regions, which privilege the southeast region [13].…”

“…For instance, the north and northeast regions of the country have lower healthy life expectancy [28], but also less access to healthcare [29]. Higher income or education has also been associated to higher healthcare utilization, with having a usual source of care (USC), with seeking preventive care, and with higher private health insurance ownership [30][31][32][33][34]. Additionally, private insurance owners seek care more often than those that do not own insurance [35].…”

Factors associated with cardiovascular disease in the Brazilian adult population: National Health Survey, 2019

“…In the present study, in the bivariate analysis, women had a higher prevalence of CVD, however, in the multivariate model, there was a higher prevalence of CVD in men. Although some studies show higher prevalence of CVD in women 18,19 , most studies point to higher risk factors, such as smoking, inadequate diet [20][21][22] , measured hypertension 23 which has been explained by behavioral and cultural issues and greater access to health services, health care and adherence to promotion and prevention practices among women [24][25][26] . Furthermore, the mortality rate, loss of healthy years of life, and disability due to CVD are higher among men 3,18,27 .…”