Abstract
ABSTRACTOBJECTIVE To characterize healthcare access and utilization among older Brazilians.METHODS Data are from the baseline wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative, population-based cohort study of persons aged 50 years and older conducted in 2015/2016 (n = 9,412). The prevalence of barriers to primary care and number and type of doctor visits in the past 12 months are compared by three main sources of healthcare (private, Family Health Strategy, traditional public clinics). Two-part multivariable hurdle analyses assess the relation between healthcare utilization, primary care problems, and source of healthcare, while controlling for healthcare determinants.RESULTS Females comprised 54% of the sample, with a mean age of 63 years. There were no demographic differences by source of healthcare. Nearly 83% had at least one doctor visit in the past 12 months, with higher use among private health plan holders. Private health plan holders most frequently visited specialists, while those using the public system were more likely to visit a general practitioner. Primary care barriers averaged 3.5 out of 12 and were the highest among those using traditional health posts. A greater number of primary care problems was negatively associated with all types of healthcare utilization.CONCLUSIONS By international standards, access to basic healthcare among older Brazilians is relatively high. Nevertheless, different levels of primary care problems between the public and private sectors and resulting utilization patterns suggest the need to continue working to close remaining gaps.
Highlights
The Brazilian national health system, the Sistema Único de Saúde (SUS)[1], is financed primarily through taxes with contributions from all levels of government
The rapid expansion of the Family Health Strategy (FHS) is independently associated with improvements in several health outcomes, including a reduction in infant mortality[5,6,7], a reduction in mortality from heart disease and in cerebrovascular deaths[8], lower rates of ambulatory care sensitive hospitalizations[9,10], and fewer complications from diabetes[11]
The main explanatory variable is the individual’s type of healthcare coverage. This is defined by those who have private health plans, those whose household was registered with the FHS, and those who have neither private health plan nor FHS coverage but are covered by the traditional public health posts
Summary
The Brazilian national health system, the Sistema Único de Saúde (SUS)[1], is financed primarily through taxes with contributions from all levels of government. Since the early 1990s, the SUS has developed and scaled up community-based primary health care through the Family Health Strategy (FHS). The FHS provides primary care to a defined population via a multi-professional healthcare team with clinical protocols and national guidelines structuring actions on chronic disease and other health problems. As of 2016, the FHS included over 42,000 teams with more than 275,000 community health agents providing care to over 130 million persons, which represents approximately 62% of the Brazilian population[3]. The FHS provides high levels of health care access[4]. The program has decreased inequities in several types of healthcare access and utilization[12,13] and contributed to enhance epidemiologic surveillance[14]
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