Abstract
BackgroundBrazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013.MethodData were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013.ResultsThe population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes.ConclusionThe results of this study support the claim that Brazil’s population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0431-8) contains supplementary material, which is available to authorized users.
Highlights
Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis
Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes
This study has shown that inequity in health care utilization in Brazil remains generally pro-rich and that the decline in pro-rich inequity observed in previous periods was not maintained in the period 2008–2013
Summary
Brazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. Brazil is a middle-income country with high income inequality and large regional disparities in health outcomes, infrastructure, and availability of public services [1,2,3,4,5]. In the SUS, primary health care is largely provided via a network of public facilities with multidisciplinary health teams that attend families living in geographically defined areas. This model of care, known as the Family Health Strategy (FHS), is based on core. In addition to the FHS, health care access was expanded with the construction of new ambulatory care facilities and the improvement of the existing public services available to everyone free of charge [12]
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