Inequities in Healthcare utilization: results of the Brazilian National Health Survey, 2013

Abstract

BackgroundThe Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil.MethodsWe employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %).Results0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class “E” (AOR = 6.31, 95 % CI = 3.76–10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78–5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30–3.74), males (AOR = 2.16, 95 % CI = 1.99–2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83–2.44). Individuals self-classified as “white” were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75–0.90).ConclusionsDespite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.

Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015

“…Inhabitants of the North—and less developed regions—visited doctors and dentists less than individuals living in the Southwest . Approximately 4% of the Brazilian population never visited a doctor or a dentist, according to the National Health Survey conducted in 2013.…”

“…Our findings showed an increased underutilization of health services in Manaus Metropolitan Region when compared with the 2013 Brazilian National Health Survey . Despite being higher than expected, the poor performance in this region was likely due to the reduced rate of healthcare services utilization .…”

A panorama of health inequalities in Brazil

“…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. The article by Lopes et al [16] highlights individual and regional factors associated with disparities in the prevalence of depression and in access to effective treatment and Theme-Filha et al [17] document inequalities in preventive cancer screening for women, regional disparities and correlation with other health behaviors.…”

Healthcare Resources Utilization and Temporary Disability in Population Aged 50-64 According to the Epidemiological Esse-Rf Study

“…Использование ресурсов системы здравоохранения может быть изучено в рамках эпиде-миологических исследований, которые позволяют про-анализировать этот фактор с учетом различных параметров, анализируемых в подобных исследованиях [6]. По данным систематического обзора, в котором обобщены результаты работ, сопоставляющих результаты опроса об обращениях за медицинской помощью с административными данными по обращаемости, показано, что опрос по использованию ресурсов системы здравоохранения позволяет получить до-стоверные данные, особенно в отношении госпитализаций и вызовов скорой медицинской помощи (СМП) [7].…”

“…Different parameters of health care resources utilization can be estimated in a framework of epidemiologic trials [6]. In accordance with a systematic review data, where findings of trials comparing results of an interrogation of medical help seeking and administrative data concerning utilization of services were generalized, the interrogation about health care resource utilization was shown to be able to receive valuable data especially concerning hospital admissions and emergency calls [7].…”