Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019

Abstract

• Health care inequality decreased for mammography and doctor visits. • For dentist visits, inequality in healthcare increased in the period. • Income and private health insurance have a strong contribution to inequalities. • The inequities are higher in the urban area, but the health care use is higher in that area. • Differences in access between urban and rural areas are still significant. This study aimed to analyze inequalities and inequities in health care for older people (50 years or more) in Brazil, in the period 1998–2019. We sought to measure and analyze the evolution of the concentration index (CI), horizontal index (HI) and decompositions of the CI. The evolution of the indices shows that there was a decrease in health care use inequities for doctor visits and mammography; in this first case the reduction was greater for rural areas, while for mammography the reduction was greater and significant for urban areas. However, despite increases in the prevalence of going to the dentist in different income strata, inequities have increased, showing that the benefits were greater for the wealthier individuals. Regarding the decomposition of factors associated with inequality, we can see that income and private health insurance appear as important variables in all cases. Thus, considering that older people increasingly demand health care, despite the advances made in this area, there are still important challenges. The inequities, mainly for mammography and dental visits, are still high and the differences between urban and rural areas are still significant, showing that public policies can be important in the search for greater equity.