Income-based disparities in health care utilisation under universal health coverage in Brazil, 2002–2003

Cataife, Guido; Courtemanche, Charles

doi:10.1080/17441692.2014.891631

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…However, this literature also points to an increase in perceived barriers to access, often related to changes in people’s expectations and overcrowding of facilities due to a growing demand for services. In terms of equity, studies have shown that individuals with less income and education and without formal employment are more likely to face barriers to care, and present lower levels of utilization, after controlling for age and health status, than their counterparts [15–17]. …”

Section: Introductionmentioning

confidence: 99%

Changes in health care inequity in Brazil between 2008 and 2013

Mullachery

Silver

Macinko

2016

Int J Equity Health

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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.

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Section: Introductionmentioning

confidence: 99%

Changes in health care inequity in Brazil between 2008 and 2013

Mullachery

Silver

Macinko

2016

Int J Equity Health

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“…[30] This has led to an increase in patient cost-sharing (e.g., out-ofpocket expenditures) for persons in the lower economic strata, as well as nearly 400,000 lawsuits related to insu cient health coverage. [50]. Two studies found that out-of-pocket health spending was higher in the groups covered by this program, even when compared to higher-income populations with private medical insurance.…”

Section: Discussionmentioning

confidence: 96%

“…Two studies found that out-of-pocket health spending was higher in the groups covered by this program, even when compared to higher-income populations with private medical insurance. [50] Colombia has also been plagued by underfunding of its subsidized POS component, as well as high rates of informal workers evading their health contributions. Insu cient funding has furthered health inequities [24].…”

Section: Discussionmentioning

confidence: 99%

Strengthening health systems to achieve Universal Health Coverage: Lessons from four Latin American countries.

Gilardino¹,

B²,

Valanzasca³

2020

Preprint

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Background: During the 1990s, health systems within several Latin American countries changed to expand service coverage and reach more people. These changes are considered the antecedent of the Universal Health Coverage (UHC). Seven years after the United Nations’ call for UHC, healthcare services in Argentina, Brazil, Colombia, Mexico are generally accessible and affordable. However, these countries increasingly struggle to meet their populations’ growing health needs while also addressing rising health care costs. This research aims to describe measures taken by these four countries to commit by UHC, addressing their barriers and challenges. Methods: This study examined literature review data, supplemented with survey data collected from regional stakeholders. Data were analyzed within an ad-hoc matrix.Results: These four countries increased healthcare services coverage by strengthening their primary healthcare systems. They also expanded coverage for non-communicable diseases, provided community outreach, and increased the number of skilled healthcare workers. New pharmaceutical support programs provided access to treatments for chronic conditions at zero cost, while high-costs drugs and cancer treatments were partially guaranteed. However, these measures did not achieve full financial protection to all, leaving citizens exposed to possible catastrophic expenditures, despite increased service coverage. UHC is funded primarily through taxes and polling resources, and these four countries still struggle to find mechanisms that could increase pooling mechanisms capable of increasing service coverage, while reducing financial inequities among people. Conclusions: Argentina, Brazil, Colombia, and Mexico have made progress towards UHC. Nevertheless, additional mechanisms to sustain financial protection are urgently required. The decentralization of the primary healthcare system, the development of public-private partnerships, and the implementation of progressive financing mechanisms like conditional cash transfers are potential manners to improve service delivery and financial protection contributing to effective UHC.

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“…Since 1988, the country introduced a public and comprehensive Unified Health System (UHS, denominated SUS in Portuguese), with emphasis on primary care on the community level, whose main pillar is the Family Health Strategy (FHS). It is executed by means of a multidisciplinary health team assisting a circumscribed population employing prevention approaches [ 15 ], professional appointments for spontaneous demands [ 16 ] and longitudinal follow-up and treatment of chronic diseases [ 17 ] including periodontal disease [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Food preferences and periodontal status of adults assisted by a public health care system

Canaan,

Costa

et al. 2023

PLoS ONE

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This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher’s discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18–39; 40–59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18–39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40–59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system.

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Income-based disparities in health care utilisation under universal health coverage in Brazil, 2002–2003

Cited by 9 publications

References 25 publications

Changes in health care inequity in Brazil between 2008 and 2013

Changes in health care inequity in Brazil between 2008 and 2013

Strengthening health systems to achieve Universal Health Coverage: Lessons from four Latin American countries.

Food preferences and periodontal status of adults assisted by a public health care system

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