The Impact Of Private Versus Public Insurance On Health Status, Work Productivity And Health Care Utilization For Individuals Residing In Brazil

Abstract

A 1 -A 2 9 8 those included in the 1-year and change analyses completed the SF-36 within 30days of their 1-year follow-up date. RESULTS: All patients contributed to the baseline analysis, and approximately 47% contributed to the 1-year and change analyses. At baseline, mean SF-6D values for all patients 50-59, 60-69, and 70-79 were 0.744 (SD=0.113), 0.743 (SD=0.105), and 0.722 (SD=0.101), respectively. At 1year, E+P arm mean values were 0.754 (SD=0.117), 0.751 (SD=0.117), and 0.725 (SD=0.109), and placebo arm mean values were 0.751 (SD=0.122), 0.748 (SD=0.109), and 0.716 (SD=0.106), respectively. The E+P arm mean changes were -0.008 (SD=0.106), -0.004 (SD=0.096), and 0.000 (SD=0.093), and the placebo arm mean changes were 0.000 (SD=0.105), -0.003 (SD=0.095), and 0.011 (SD=0.093), respectively. CONCLUSIONS: We found minimally decreasing utilities among older age groups, and little variability between utilities by hormone replacement therapy use. These results may be particularly useful in future health economic evaluations of aging women given that they are derived from a large randomized sample, and age group specific. However, our findings may be limited by the homogeneity and representativeness of the E+P trial participants.OBJECTIVES: National health care policy in Brazil is delivered via a two-tiered (public/private) system. Controversy exists since access to private insurance is skewed towards those with higher socioeconomic status, with 75% having incomes >5x the minimum wage, and 95% living in urban areas, mainly in the South and Southeast regions. Our objective was to assess the impact on health status, productivity and health care utilization due to insurance type among patients residing in different regions of Brazil. METHODS: Data were analyzed from the 2011 National Health and Wellness Survey, a nation-wide survey of adults in Brazil (N=12,000). Health status (SF-12v2), work productivity loss (WPAI), and health care resource use within a six-month time frame were compared across individuals in different insurance type strata (i.e., public/private). Data were also stratified according to Brazilian regions comprising the Mid-West, North, Northeast, South and Southeast, and the Federal District. Statistics included unpaired Student-t and Chi-square tests. ANOVA was used to test differences among regions of Brazil. RESULTS: A total 11,985 individuals comprised the public (N=6,074) and private (N=5,911) insurance assessment. Health care utilization was significantly lower among individuals with private insurance (physician consultations: 70.9% versus 86.0%; emergency room visits: 19.6% versus 25.7%; and hospitalizations: 8.9% versus 11.0%; all p<0.05). Overall work impairment (i.e., absenteeism and presenteeism combined) was also significantly lower in the private insurance group (difference=2.8%, 95%CI=1.3%-4.3%). Mental SF-12 score favored those with private insurance (difference=0.058, 95%CI=0.022-0.095), whereas physical SF-12 score favored those with the public insurance (difference=0.062, 95%CI=0.035...

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

“…Three included studies, which included 285,570 participants, reported the percentage of study participants who had visited the ED [ 24 , 26 , 32 ]. The proportion of those with private insurance who visited the ED was similar to the proportion of people without private insurance who visited the ED.…”

“…4 c). In Additional file 1 , we present the data pertaining to outpatient visits that could not be included in the meta-analysis (9 articles) [ 15 – 18 , 21 , 25 , 32 , 37 , 38 ]. The favorable results (more outpatient visits) for both people with private insurance and people without private insurance were reported.…”

“…We used the data from 7 studies, which included > 500,000,000 participants in determining the OR for the rate of hospitalization among those with private insurance, compared with those without private insurance [ 15 , 20 , 25 , 29 , 32 , 34 , 38 ]. The OR for the pooled results was 1.00 (95% CI 0.58–1.70) (see forest plot in Fig.…”