Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008 Análisis de la evolución y los determinantes de las desigualdades relacionadas con los ingresos en el sistema de salud de Brasil, 1998 - 2008

• Main Authors: Gisele Almeida, Flavia Mori Sarti, Fernando Fagundes Ferreira, Maria Dolores Montoya Diaz, Antonio Carlos Coelho Campino
• Format: Article in Journal/Newspaper
• Language: English; Spanish; Portuguese
• Published: Pan American Health Organization 2013
• Subjects: Equidad en el acceso; equidad en salud; sistemas de salud; política de salud; Brasil; Equity in access; equity in health; health systems; health policy; Brazil; Medicine; R; Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doaj.org/article/9dc480b8592041a8a5c07868942fdf03

OBJECTIVE: To analyze the evolution and determinants of income-related inequalities in the Brazilian health system between 1998 and 2008. METHODS: Data from the National Household Sampling Surveys of 1998, 2003, and 2008 were used to analyze inequalities in health and health care. Health was measured by self-reported health status, physical limitations, and chronic illness. Hospitalization and physician and dentist visits were proxies for health care utilization. Income was a proxy for socioeconomic status. Concentration indices were calculated before and after standardization for all dependent variables. Decomposition analysis was used to identify the main determinants of inequality in health care utilization. RESULTS: In all three periods analyzed, the poor reported worse health status, while the wealthy reported more chronic diseases; health care utilization was pro-rich for medical and dental services. Yet, income-related inequality in health care utilization has been declining. Private health insurance, education, and income are the major contributors to the inequalities identified. CONCLUSIONS: Income-related inequality in the use of medical and dental health care is gradually declining in Brazil. The decline is associated with implementation of pro-equity policies and programs, such as the Community Health Agents Program and the Family Health Program. OBJETIVOS: Analizar la evolución y los determinantes de las desigualdades relacionadas con los ingresos en el sistema de salud brasileño entre 1998 y 2008. MÉTODOS: Se utilizaron los datos de la Encuesta Nacional de Hogares de 1998, 2003 y 2008. La salud se midió según el estado de salud autoevaluado, las limitaciones físicas y las enfermedades crónicas. Las hospitalizaciones y las consultas médicas y odontológicas se usaron como medición indirecta de la utilización de la atención sanitaria, y los ingresos para estimar el nivel socioeconómico. Los índices de concentración para todas las variables dependientes se calcularon antes y después de su ...