Changes in health care inequity in Brazil between 2008 and 2013

Abstract

BackgroundBrazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013.MethodData were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013.ResultsThe population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes.ConclusionThe results of this study support the claim that Brazil’s population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0431-8) contains supplementary material, which is available to authorized users.

A panorama of health inequalities in Brazil

“…In relation to heath services and the performance of the Brazilian national health system, França et al [12] document important reductions in inequalities in reproductive and maternal health interventions over the past 4 decades, while Mullachery et al [13] show a slight deceleration in progress made in assuring equitable access to healthcare services since 2008. Boccolini et al [14] identify characteristics of the more than 20 million people who still underutilize the Brazilian health system and Dourado et al [15] demonstrate the importance of the Family Health Strategy in providing a usual source of healthcare as well as remaining regional disparities in its distribution.…”

Area‐level social development and indicators of public dental services in Southern Brazil

“…The findings of the present study substantiate these findings regarding the outcome of public dental health service coverage. Public dental services provided through primary healthcare centres are also shown to promote use by women, older people, unemployed and other socially disadvantaged population groups . However, a generalization of these findings to other outcomes of public dental services should be avoided as noted with the outcomes of the proportion of extractions and STB in the current study.…”

“…Public dental services provided through primary healthcare centres are also shown to promote use by women, older people, unemployed and other socially disadvantaged population groups. 10,12,14,34,36 However, a generalization of these findings to other outcomes of public dental services should be avoided as noted with the outcomes of the proportion of extractions and STB in the current study. Social inequality in the use of and access to dental services has also been confirmed in both public and private services.…”

“…20,21 Public dental coverage a TA B L E 3 Explained component of the public dental health service coverage between fluoridated and nonfluoridated municipalities obtained by decomposition analysis Previous examination of associations between state-level HDI and public dental service indicators has shown negative correlations with the outcomes of public dental health service coverage and lack of association with outcomes of STB. 11 Besides, studies 12,34 have shown that the expansion of primary healthcare provision 12,35 and also public dental services based on primary healthcare centres 10,11,17,36 aim to reach out to the poorest areas and vulnerable people. The findings of the present study substantiate these findings regarding the outcome of public dental health service coverage.…”

Oral health-related quality of life in elderly women participating in a coexistence group in southern Brazil: Oral health and quality of life in elderly women

“…The Brazilian regions present great inequality in the utilization of dental care and in people’s oral health condition if we consider the access to services. The most vulnerable groups, such as rural populations, elders and poor people, with less schooling, have the worst oral health conditions and face more obstacles in the use of health services [2-3].…”