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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2023

Open Access 01-12-2023 | Care | Research

Persistent inequalities in health care services utilisation in Brazil (1998–2019)

Authors: Maíra Coube, Zlatko Nikoloski, Matías Mrejen, Elias Mossialos

Published in: International Journal for Equity in Health | Issue 1/2023

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Abstract

Background

One of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no comprehensive and up-to-date studies focused on inequalities in both curative and preventive health care services utilisation.

Methods

We evaluated data from the National Household Sample Survey and the Brazilian National Health Survey, which are two nationally representative studies that include findings from 1998, 2003, and 2008 and 2013 and 2019, respectively. We calculated Erreygers-corrected Concentration Indices (CInds) to evaluate the magnitude of socioeconomic-related inequalities associated with five indicators of health care services utilisation, including physician visits, hospital admissions, surgical procedures, Pap smears, and mammograms. The main factors associated with these inequalities were identified via a decomposition analysis of the calculated CInds.

Results

While the results of our analysis revealed persistent inequalities in health care services utilisation that favour the wealthy, we found that the overall magnitude of these inequalities decreased over time. The largest inequalities were observed in the utilisation of preventive care services (Pap smears and mammograms) and services available in the poorest regions of the country. Except for admissions for labour and delivery, our findings revealed that wealthier individuals were more likely to utilise hospital services; this represents a change from findings reported in previous years. Private health insurance coverage and individual socioeconomic status are significantly associated with inequalities in health care services utilisation throughout Brazil.

Conclusions

Collectively, our findings suggest that we must continue to monitor potential inequalities in health care service utilisation to determine whether Brazilian policy objectives focused on improved health outcomes for all will ultimately be achieved.
Appendix
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Metadata
Title
Persistent inequalities in health care services utilisation in Brazil (1998–2019)
Authors
Maíra Coube
Zlatko Nikoloski
Matías Mrejen
Elias Mossialos
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
International Journal for Equity in Health / Issue 1/2023
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-023-01828-3

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