Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey

Detalhes bibliográficos
Autor(a) principal: Szwarcwald, Celia Landmann
Data de Publicação: 2010
Outros Autores: Souza Junior, Paulo Roberto Borges de, Damacena, Giseli Nogueira
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/2623
Resumo: Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil
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spelling Szwarcwald, Celia LandmannSouza Junior, Paulo Roberto Borges deDamacena, Giseli Nogueira2011-05-09T13:20:22Z2011-05-09T13:20:22Z2010SZWARCWALD, C. L.; SOUZA-JÚNIOR, P.R.B.; DAMACENA, G. N. Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey. BMC Health Services Research, v.10, n.217, 2010.1472-6963https://www.arca.fiocruz.br/handle/icict/262310.1186/1472-6963-10-217engSistemas de SaúdeDisparidades nos Níveis de SaúdeCondições SocioeconômicasSocioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Surveyinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, BrasilBackground: The Brazilian health system is founded on the principle of equity, meaning provision of equal care for equal needs. However, little is known about the impact of health policies in narrowing socioeconomic health inequalities. Using data from the Brazilian World Health Survey, this paper addresses socioeconomic inequalities in the use of outpatient services according to intensity of need. Methods: A three-stage cluster sampling was used to select 5000 adults (18 years and over). The non-response rate was 24.7% and calibration of the natural expansion factors was necessary to obtain the demographic structure of the Brazilian population. Utilization was established by use of outpatient services in the 12 months prior to the interview. Socioeconomic inequalities were analyzed by logistic regression models using years of schooling and private health insurance as independent variables, and controlling by age and sex. Effects of the socioeconomic variables on health services utilization were further analyzed according to self-rated health (good, fair and poor), considered as an indicator of intensity of health care need. Results: Among the 5000 respondents, 63.4% used an outpatient service in the year preceding the survey. The association of health services utilization and self-rated health was significant (p < 0.001). Regarding socioeconomic inequalities, the less educated used health services less frequently, despite presenting worse health conditions. Highly significant effects were found for both socioeconomic variables, years of schooling (p < 0.001) and private health insurance (p < 0.00), after controlling for age and sex. Stratifying by self-rated health, the effects of both socioeconomic variables were significant among those with good health status, but not statistically significant among those with poor self-rated health. Conclusions: The analysis showed that the social gradient in outpatient services utilization decreases as the need is more intense. Among individuals with good self-rated health, possible explanations for the inequality are the lower use of preventive services and unequal supply of health services among the socially disadvantaged groups, or excessive use of health services by the wealthy. On the other hand, our results indicate an adequate performance of the Brazilian health system in narrowing socioeconomic inequalities in health in the most serious situations of need.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZORIGINALSocioeconomic inequalities_2010.pdfSocioeconomic inequalities_2010.pdfapplication/pdf324106https://www.arca.fiocruz.br/bitstream/icict/2623/1/Socioeconomic%20inequalities_2010.pdf905ad7beab88a97567ec35b4762ea3daMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-81648https://www.arca.fiocruz.br/bitstream/icict/2623/2/license.txte095249ac7cacefbfe39684dfe45e706MD52TEXTSocioeconomic inequalities_2010.pdf.txtSocioeconomic inequalities_2010.pdf.txtExtracted texttext/plain37446https://www.arca.fiocruz.br/bitstream/icict/2623/5/Socioeconomic%20inequalities_2010.pdf.txte179535e22b8e4c456a0cc8e7cd86f1aMD55THUMBNAILSocioeconomic inequalities_2010.pdf.jpgSocioeconomic inequalities_2010.pdf.jpgGenerated Thumbnailimage/jpeg2286https://www.arca.fiocruz.br/bitstream/icict/2623/4/Socioeconomic%20inequalities_2010.pdf.jpgb3f6bbe6c9de7f7afb472062a656106fMD54icict/26232023-08-03 12:16:32.831oai:www.arca.fiocruz.br:icict/2623Tk9OLUVYQ0xVU0lWRSBESVNUUklCVVRJT04gTElDRU5TRQoKQnkgc2lnbmluZyBhbmQgc3VibWl0dGluZyB0aGlzIGxpY2Vuc2UsIHlvdSAodGhlIGF1dGhvcihzKSBvciBjb3B5cmlnaHQKb3duZXIpIGdyYW50cyB0byBEU3BhY2UgVW5pdmVyc2l0eSAoRFNVKSB0aGUgbm9uLWV4Y2x1c2l2ZSByaWdodCB0byByZXByb2R1Y2UsCnRyYW5zbGF0ZSAoYXMgZGVmaW5lZCBiZWxvdyksIGFuZC9vciBkaXN0cmlidXRlIHlvdXIgc3VibWlzc2lvbiAoaW5jbHVkaW5nCnRoZSBhYnN0cmFjdCkgd29ybGR3aWRlIGluIHByaW50IGFuZCBlbGVjdHJvbmljIGZvcm1hdCBhbmQgaW4gYW55IG1lZGl1bSwKaW5jbHVkaW5nIGJ1dCBub3QgbGltaXRlZCB0byBhdWRpbyBvciB2aWRlby4KCllvdSBhZ3JlZSB0aGF0IERTVSBtYXksIHdpdGhvdXQgY2hhbmdpbmcgdGhlIGNvbnRlbnQsIHRyYW5zbGF0ZSB0aGUKc3VibWlzc2lvbiB0byBhbnkgbWVkaXVtIG9yIGZvcm1hdCBmb3IgdGhlIHB1cnBvc2Ugb2YgcHJlc2VydmF0aW9uLgoKWW91IGFsc28gYWdyZWUgdGhhdCBEU1UgbWF5IGtlZXAgbW9yZSB0aGFuIG9uZSBjb3B5IG9mIHRoaXMgc3VibWlzc2lvbiBmb3IKcHVycG9zZXMgb2Ygc2VjdXJpdHksIGJhY2stdXAgYW5kIHByZXNlcnZhdGlvbi4KCllvdSByZXByZXNlbnQgdGhhdCB0aGUgc3VibWlzc2lvbiBpcyB5b3VyIG9yaWdpbmFsIHdvcmssIGFuZCB0aGF0IHlvdSBoYXZlCnRoZSByaWdodCB0byBncmFudCB0aGUgcmlnaHRzIGNvbnRhaW5lZCBpbiB0aGlzIGxpY2Vuc2UuIFlvdSBhbHNvIHJlcHJlc2VudAp0aGF0IHlvdXIgc3VibWlzc2lvbiBkb2VzIG5vdCwgdG8gdGhlIGJlc3Qgb2YgeW91ciBrbm93bGVkZ2UsIGluZnJpbmdlIHVwb24KYW55b25lJ3MgY29weXJpZ2h0LgoKSWYgdGhlIHN1Ym1pc3Npb24gY29udGFpbnMgbWF0ZXJpYWwgZm9yIHdoaWNoIHlvdSBkbyBub3QgaG9sZCBjb3B5cmlnaHQsCnlvdSByZXByZXNlbnQgdGhhdCB5b3UgaGF2ZSBvYnRhaW5lZCB0aGUgdW5yZXN0cmljdGVkIHBlcm1pc3Npb24gb2YgdGhlCmNvcHlyaWdodCBvd25lciB0byBncmFudCBEU1UgdGhlIHJpZ2h0cyByZXF1aXJlZCBieSB0aGlzIGxpY2Vuc2UsIGFuZCB0aGF0CnN1Y2ggdGhpcmQtcGFydHkgb3duZWQgbWF0ZXJpYWwgaXMgY2xlYXJseSBpZGVudGlmaWVkIGFuZCBhY2tub3dsZWRnZWQKd2l0aGluIHRoZSB0ZXh0IG9yIGNvbnRlbnQgb2YgdGhlIHN1Ym1pc3Npb24uCgpJRiBUSEUgU1VCTUlTU0lPTiBJUyBCQVNFRCBVUE9OIFdPUksgVEhBVCBIQVMgQkVFTiBTUE9OU09SRUQgT1IgU1VQUE9SVEVECkJZIEFOIEFHRU5DWSBPUiBPUkdBTklaQVRJT04gT1RIRVIgVEhBTiBEU1UsIFlPVSBSRVBSRVNFTlQgVEhBVCBZT1UgSEFWRQpGVUxGSUxMRUQgQU5ZIFJJR0hUIE9GIFJFVklFVyBPUiBPVEhFUiBPQkxJR0FUSU9OUyBSRVFVSVJFRCBCWSBTVUNICkNPTlRSQUNUIE9SIEFHUkVFTUVOVC4KCkRTVSB3aWxsIGNsZWFybHkgaWRlbnRpZnkgeW91ciBuYW1lKHMpIGFzIHRoZSBhdXRob3Iocykgb3Igb3duZXIocykgb2YgdGhlCnN1Ym1pc3Npb24sIGFuZCB3aWxsIG5vdCBtYWtlIGFueSBhbHRlcmF0aW9uLCBvdGhlciB0aGFuIGFzIGFsbG93ZWQgYnkgdGhpcwpsaWNlbnNlLCB0byB5b3VyIHN1Ym1pc3Npb24uCg==Repositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352023-08-03T15:16:32Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.pt_BR.fl_str_mv Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
title Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
spellingShingle Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
Szwarcwald, Celia Landmann
Sistemas de Saúde
Disparidades nos Níveis de Saúde
Condições Socioeconômicas
title_short Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
title_full Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
title_fullStr Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
title_full_unstemmed Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
title_sort Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey
author Szwarcwald, Celia Landmann
author_facet Szwarcwald, Celia Landmann
Souza Junior, Paulo Roberto Borges de
Damacena, Giseli Nogueira
author_role author
author2 Souza Junior, Paulo Roberto Borges de
Damacena, Giseli Nogueira
author2_role author
author
dc.contributor.author.fl_str_mv Szwarcwald, Celia Landmann
Souza Junior, Paulo Roberto Borges de
Damacena, Giseli Nogueira
dc.subject.por.fl_str_mv Sistemas de Saúde
Disparidades nos Níveis de Saúde
Condições Socioeconômicas
topic Sistemas de Saúde
Disparidades nos Níveis de Saúde
Condições Socioeconômicas
description Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil
publishDate 2010
dc.date.issued.fl_str_mv 2010
dc.date.accessioned.fl_str_mv 2011-05-09T13:20:22Z
dc.date.available.fl_str_mv 2011-05-09T13:20:22Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv SZWARCWALD, C. L.; SOUZA-JÚNIOR, P.R.B.; DAMACENA, G. N. Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey. BMC Health Services Research, v.10, n.217, 2010.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/2623
dc.identifier.issn.none.fl_str_mv 1472-6963
dc.identifier.doi.none.fl_str_mv 10.1186/1472-6963-10-217
identifier_str_mv SZWARCWALD, C. L.; SOUZA-JÚNIOR, P.R.B.; DAMACENA, G. N. Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey. BMC Health Services Research, v.10, n.217, 2010.
1472-6963
10.1186/1472-6963-10-217
url https://www.arca.fiocruz.br/handle/icict/2623
dc.language.iso.fl_str_mv eng
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