Horizontal equity in health care utilization in Brazil, 1998–2008

Abstract

IntroductionThis study assesses trends in horizontal equity in the utilization of healthcare services from 1998 to 2008--a period of major economic and social change in Brazil.MethodsData are from nationally representative surveys repeated in 1998, 2003, and 2008. We apply established methods for assessing horizontal inequity in healthcare access (the principle that people with the same healthcare needs should have similar access to healthcare services). Horizontal inequity is calculated as the difference between observed healthcare utilization and utilization predicted by healthcare needs. Outcomes examined include the probability of a medical, dental, or hospital visit during the past 12 months; any health service use in the past two weeks; and having a usual source of healthcare. We use monthly family income to measure differences in socioeconomic position. Healthcare needs include age, sex, self-rated health, and chronic conditions. Non-need factors include income, education, geography, health insurance, and Family Health Strategy coverage.ResultsThe probability of having at least one doctor visit in the past 12 months became substantially more equitable over time, ending with a slightly pro-rich orientation in 2008. Any hospitalization in the past 12 months was found to be pro-poor in all periods but became slightly less so in 2008. Dental visits showed the largest absolute decrease in horizontal inequity, although they were still the most inequitably (pro-rich) distributed outcome in 2008. Service use in the past two weeks showed decreased inequity in 2003 but exhibited no significant change between 2003 and 2008. Having a usual source of care became less pro-rich over time and was nearly income-neutral by 2008. Factors associated with greater inequities include income, having a private health plan, and geographic location. Factors associated with greater equity included health needs, schooling, and enrolment in the Family Health Strategy.ConclusionsHealthcare utilization in Brazil appears to have become increasingly equitable over the past 10 years. Although this does not imply that equity in health outcomes has improved correspondingly, it does suggest that government policies aimed at increasing access, especially to primary care, have helped to make healthcare utilization in Brazil fairer over time.

Influência de fatores estruturais e organizacionais no desempenho da atenção primária à saúde em Belo Horizonte, Minas Gerais, Brasil, na avaliação de gestores e enfermeiros

“…No Brasil, a expansão da APS vem ocorrendo por meio da Estratégia Saúde da Família (ESF) desde sua implantação em 1994 3 . Investigações têm mostrado que essa estratégia é efetiva para reduzir a mortalidade infantil 4,5 , as hospitalizações por condições sensíveis à APS 6,7,8,9 e as iniquidades na utilização dos serviços 10,11 .…”

Comportamentos em saúde e exames preventivos entre adultos filiados ou não a planos de saúde na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil, 2003-2010

“…O Brasil passou por marcantes transformações sociais na primeira década dos anos 2000, e há evidências de que possam ter proporcionado maior equidade na utilização de serviços de saúde 60 . Em situações em que há forte atuação das políticas públicas, como na implantação do programa nacional de controle de DCNT 61 e incremento do Programa Saúde da Família 62 , as mudanças em direção a hábitos de vidas mais saudáveis e na realização de exames preventivos são claramente mais positivas.…”

Urbanization and Inequality in Hypertension Diagnosis and Medication in Indonesia

“…They show that the utilization of curative visits and hospitalization is more concentrated among the better-off in the country and find no significant change during the period. Macinko and Lima-Costa (2012) research the case for Brazil. They examine inequality in 1998, 2003, and 2008 and find that healthcare utilization in Brazil, which had a pro-rich orientation, became increasingly equitable during the period.…”