Persistent inequalities in health care services utilisation in Brazil (1998–2019)

Abstract

Background One of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no comprehensive and up-to-date studies focused on inequalities in both curative and preventive health care services utilisation. Methods We evaluated data from the National Household Sample Survey and the Brazilian National Health Survey, which are two nationally representative studies that include findings from 1998, 2003, and 2008 and 2013 and 2019, respectively. We calculated Erreygers-corrected Concentration Indices (CInds) to evaluate the magnitude of socioeconomic-related inequalities associated with five indicators of health care services utilisation, including physician visits, hospital admissions, surgical procedures, Pap smears, and mammograms. The main factors associated with these inequalities were identified via a decomposition analysis of the calculated CInds. Results While the results of our analysis revealed persistent inequalities in health care services utilisation that favour the wealthy, we found that the overall magnitude of these inequalities decreased over time. The largest inequalities were observed in the utilisation of preventive care services (Pap smears and mammograms) and services available in the poorest regions of the country. Except for admissions for labour and delivery, our findings revealed that wealthier individuals were more likely to utilise hospital services; this represents a change from findings reported in previous years. Private health insurance coverage and individual socioeconomic status are significantly associated with inequalities in health care services utilisation throughout Brazil. Conclusions Collectively, our findings suggest that we must continue to monitor potential inequalities in health care service utilisation to determine whether Brazilian policy objectives focused on improved health outcomes for all will ultimately be achieved.

Social determinants of gastrointestinal malformation mortality in Brazil: a national study

“… 30 For instance, Brazil comprises five regions with significant differences and inequities. 31 The South and Southeast regions, which presented the lowest mortality rates in our study, are characterized by their wealth and hold most of the nation’s GDP. 32 The Southeast region, the second-smallest region in Brazil, holds over 44% of the country’s population and contributes to over half of the national GDP.…”

Decreased Long-Term Survival of Patients With Newly Diagnosed Cancer Discharged Home After Unplanned ICU Admission: A Prospective Observational Study

“…Brazil has both public and private healthcare payment models. It has been shown that patients in the public model have lower levels of education, income and access to healthcare compared with patients in the private model (44, 45).…”

Improving access to cancer clinical research in Brazil: recent advances and new opportunities. Expert opinions from the 4th CURA meeting, São Paulo, 2023

“…The concentration of clinical research centres in high-developed regions in Brazil is only an additional topic of the major centralisation of health care services, which hinders accessibility [ 39 ]. Accessibility is an important factor associated with variations in the use of health systems, thus poor geographic accessibility to healthcare services contributes to low utilisation, which in turn gives rise to poorer health outcomes [ 40 ].…”