Is Universal Health Care in Brazil Really Universal?

Cataife, Guido; Courtemanche, Charles

doi:10.2139/ssrn.1690662

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…Findings reported in this study are supported by evidence from other studies in the literature (5,22,23). Although the evidence here suggests that incomerelated inequalities in utilization of medical and dental services are slowly declining in the country, these inequalities remain significant.…”

Section: Discussionsupporting

confidence: 88%

Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008

Almeida¹,

Sarti

Ferreira

et al. 2013

Rev Panam Salud Publica

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Section: Discussionsupporting

confidence: 88%

Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008

Almeida¹,

Sarti

Ferreira

et al. 2013

Rev Panam Salud Publica

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show abstract

“…6,16 Although one might argue on whether the evaluations of these centers are representative of the usual approach for Brazilian tertiary clinics, and whether south and southeast regions could represent the country as a whole, it may be speculated that the cities evaluated are among the greatest populations in Brazil, therefore represent it for purposes of outlining general treatment approaches. 15 Another point of criticism of this study is the impossibility of determining the reasons why different approaches were observed. The influence of being trained or influenced by different schools' approaches (European and American) could have represented the underlying reason why some preferred monotherapy while others chose combination of drugs.…”

Section: Discussionmentioning

confidence: 89%

“…There is no doubt that the pharmacological treatment of migraine in Brazil varies among tertiary centers in relation to the targeted patients. Public or free‐of‐charge centers deliver headache care based on monotherapy regardless of the headache impact, previous seeking for treatment and outcome of the patients . In addition, and this is not the scope of this review, patients lack education and frequently peregrinate among services throughout the cities without ever initiating prevention or understanding migraine as a chronic disease .…”

Section: Discussionmentioning

confidence: 99%

“…Most of the times, the physician simply repeats the medication during the follow‐up visits, sometimes adjusting dosages in very short lasting consultations . Although one might argue on whether the evaluations of these centers are representative of the usual approach for Brazilian tertiary clinics, and whether south and southeast regions could represent the country as a whole, it may be speculated that the cities evaluated are among the greatest populations in Brazil, therefore represent it for purposes of outlining general treatment approaches …”

Section: Discussionmentioning

confidence: 99%

“…Public or free-of-charge centers deliver headache care based on monotherapy regardless of the headache impact, previous seeking for treatment and outcome of the patients. 14,15 In addition, and this is not the scope of this review, patients lack education and frequently peregrinate among services throughout the cities without ever initiating prevention or understanding migraine as a chronic disease. 6,14,16,17 Moreover, the option for the chosen drug generally depends on availability of few specific free samples irregularly supplied by pharmaceutical industries and on a short list of medications officially available for handing out to the patients for free, therefore resulting in prescription bias.…”

Section: Discussionmentioning

confidence: 99%

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The Pharmacological Treatment of Migraine in Brazil

Krymchantowski¹,

Jevoux²

2015

Headache

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There is no consensus on whether patients turning to private tertiary centers are different from those seen in public nonpaying services. However, since it is directly related to economic status and public services may render free specific medications as well as official dispensation of work, it may be argued that patients have less headache impact, and suboptimal care is delivered in these instances. As for the studied private centers as well as for the few public excellence centers, care provided is usually varied, includes a combination of drugs, and prevention is commonly used.

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Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil

García-Subirats

Vargas

Mogollón-Pérez

et al. 2014

Int J Equity Health

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IntroductionHealth system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia.MethodsA cross-sectional study was conducted based on a survey of a multistage probability sample of people who had had at least one health problem in the prior three months (2,163 in Colombia and 2,167 in Brazil). The outcome variables were dichotomous variables on the utilization of curative and preventive services. The main independent variables were income, being the holder of a private health plan and, in Colombia, type of insurance scheme of the General System of Social Security in Health (SGSSS). For each country, the prevalence of the outcome variables was calculated overall and stratified by levels of per capita income, SGSSS insurance schemes and private health plan. Prevalence ratios were computed by means of Poisson regression models with robust variance, controlling for health care need.ResultsThere are inequities in favor of individuals of a higher socioeconomic status: in Colombia, in the three different care levels (primary, outpatient secondary and emergency care) and preventive activities; and in Brazil, in the use of outpatient secondary care services and preventive activities, whilst lower-income individuals make greater use of the primary care services. In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels. Income in both countries, insurance scheme enrollment in Colombia and holding a private health plan in Brazil all contribute to the presence of inequities in utilization.ConclusionsTwenty years after the introduction of reforms implemented to improve equity in access to health care, inequities, defined in terms of unequal use for equal need, are still present in both countries. The design of the health systems appears to determine access to the health services: two insurance schemes in Colombia with different benefits packages and a segmented system in Brazil, with a significant private component.

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Is Universal Health Care in Brazil Really Universal?

Cited by 6 publications

References 26 publications

Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008

Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008

The Pharmacological Treatment of Migraine in Brazil

Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil

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