Utilization of the Brazilian public health system by privately insured individuals: a literature review

Abstract

More than one in four Brazilians have private health insurance (PHI), even thought it covers mostly the same procedures as the Brazilian Unified National Health System (SUS). This literature review included articles and monographs published since 1990 about the utilization of SUS by privately insured individuals. Considering outpatient care and hospitalization, privately insured people in Brazil use SUS in approximately 13% of the times they receive health care, and approximately 7% of people receiving care paid by SUS are privately insured; these findings vary depending on the type of service studied and on study methods. Utilization of SUS is more frequent in less developed regions, by people with more restricted PHI plans and by people with worse health status. Privately insured people report the limitations of PHI plans as their reasons for resorting to SUS. Sometimes, beneficiaries of PHI plans owned by nonprofit hospitals (which also provide health care financed by SUS) have easier access to care than uninsured people financed by SUS. Anecdotally, privately insured people are satisfied with SUS, but not to the point of adopting SUS as their preferred source of care. In short, for privately insured people, SUS only plays a secondary role in their health care. Despite PHI taking over part of the SUS’s health care demand, PHI represents a restriction of the universal, equitable character of the SUS.

Utilization of public health care by people with private health insurance: a systematic review and meta-analysis

“…As most countries across the world face rapidly escalating health expenditures, exorbitant out-of-pocket payments have resulted in high demand for supplementary private health insurance [1,2]. For instance, in 2015, approximately 80% of households in the United States had to purchase at least one private health insurance plan, and more than 25% of Brazilians had private health insurance in 2019 [3,4].…”

“…Although previous studies have examined the effect of private insurance on the utilization of public health care in specific countries [3,6], no study published to date has systematically investigated the issue on a global scale. However, it is necessary for stakeholders to understand the role that private insurance companies play the use of healthcare services from a macro perspective.…”

Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil

“…The latter is easy to understand, as it is directly related to individuals' purchasing power. Furthermore, a literature review has shown that individuals with health insurance are doubled covered by public and private services using the Brazilian Unified Health System when insurances do not cover the type of service required or use hospitals financed by the public sector 30 . The indicator consulting a physical education professional tends to present a much lower prevalence among the poorest groups, even with the recent increase in the access to this professional by the public health system due to its inclusion in some policies of the Brazilian Unified Health System.…”

Avaliação da qualidade da Atenção Primária à Saúde em Fortaleza, Brasil, na perspectiva dos usuários adultos no ano de 2019

“…As características sociodemográficas e epidemiológicas dos 233 participantes da pesquisa são corroboradas por vários estudos nacionais que mostram que, historicamente, dentre os usuários do SUS, há predomínio de mulheres, pretos e pardos, baixa escolaridade, baixa renda e sem posse de plano de saúde privado [30][31][32][33] . Não houve grande prevalência de pessoas com doenças crônicas, apesar de sabido que usuários com doenças crônicas utilizam mais os serviços de saúde 34 .…”