Abstract
ABSTRACTOBJECTIVE To investigate the use of health services among adults living in Manaus, Amazonas.METHODS This was a panel of two cross-sectional studies conducted in Manaus in 2015 and 2019. Individuals aged ≥ 18 years were selected by probabilistic sampling and interviewed at home. The study outcomes were doctor visits and hospitalizations in the previous 12 months, and unmet surgical needs. Variations between 2015 and 2019 were tested using chi-squared goodness-of-fit test. Poisson regression with robust variance was employed to calculate the prevalence ratios (PR) of the outcomes with 95% confidence intervals (95%CI).RESULTS The surveys included 5,800 participants in total. Visits to the doctor decreased from 2015 (78.7%) to 2019 (76.3%; p < 0.001), hospital admissions increased from 2015 (7.9%) to 2019 (11.5%; p < 0.001), and unmet surgical needs decreased in the period (15.9% to 12.1%; p < 0.001). These variations were particularly observed in vulnerable individuals – sicker; poorer; non-whites; and those belonging to lower social classes, with less access to education, formal jobs, and health insurance (p < 0.05). Doctor visits were higher in people with fair health status (PR = 1.09; 95%CI 1.06–1.12), health insurance (PR = 1.13; 95%CI 1.09–1.17), and chronic diseases (p < 0.001) but lower in men (PR = 0.87; 95%CI 0.84–0.90) and informal workers (PR = 0.89; 95%CI 0.84–0.94). Hospitalizations were higher in people with worse health statuses (p < 0.001), without partners (PR = 1.27; 95%CI 1.05–1.53), and with multimorbidity (PR = 1.68; 95%CI 1.33–2.12) but lower in men (PR = 0.55; 95%CI 0.44–0.68), older adults (p < 0.001), informal workers (PR = 0.67; 95%CI 0.51–0.89), and unemployed (PR = 0.72; 95%CI 0.53–0.97). Unmet surgical needs were higher in older adults (p < 0.001), middle-class people (PR = 1.24; 95%CI 1.01–1.55), worse health statuses (p < 0.001), and chronic diseases (p < 0.001) but lower in men (PR = 0.76; 95%CI 0.65–0.86).CONCLUSIONS From 2015 to 2019, less people visited the doctor, more were admitted to hospitals, and less were in need of surgery or aware of that need, potentially indicating poorer access to health services.
Highlights
The use of health services comprises the direct and indirect contacts with healthcare resources and is associated with individual, financial, cultural, and health system factors[1,2]
Out of the 3,479 participants interviewed in Manaus in 2015, 78.7% (95%confidence intervals (CI) 77.4%–80.1%) visited a doctor and 7.9% (95%CI 6.9%–8.8%) were hospitalized in the previous 12 months, while 15.9% (95%CI 14.7%–17.2%) reported unmet surgical need
Doctor visits were more frequent in people with fair health status, health insurance, and chronic diseases and negatively associated with men and informal workers
Summary
The use of health services comprises the direct and indirect contacts with healthcare resources and is associated with individual, financial, cultural, and health system factors[1,2]. Access to health care is measured by health services utilization, since the use of such resources demonstrates the access[3,4]. Over 70% of the Brazilian population visited a doctor and one-tenth were hospitalized in the previous year up to 2017, with lower utilization in the Northern region[6]. The Brazilian population has relevant gaps in healthcare resources utilization, especially for the most vulnerable individuals[7]. Regional differences occur: the most developed areas, such as the Southeast and South regions, presented the highest levels of access to health services in a previous national survey conducted in 20138
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