Use of and access to health services in Brazil, 2013 National Health Survey

Stopa, Sheila Rizzato; Malta, Deborah Carvalho; Monteiro, Camila Nascimento; Szwarcwald, Célia Landmann; Goldbaum, Moisés; Cesar, Chester Luiz Galvão

doi:10.1590/S1518-8787.2017051000074

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Brasil

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Original Articles • Rev. Saúde Pública 51 (suppl 1) • 2017 • https://doi.org/10.1590/S1518-8787.2017051000074 copy

Use of and access to health services in Brazil, 2013 National Health Survey

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the use of health services in the Brazilian population by sociodemographic factors, according to data from the 2013 Brazilian National Health Survey.

METHODS

The study analyzed data from 205,000 Brazilian citizens in all age groups who participated in the Brazilian National Health Survey, a cross-sectional study carried out in 2013. Prevalence and confidence intervals were estimated for indicators related to access to and use of health services according to age group, level of education of head of household, and Brazilian macroregions.

RESULTS

Among individuals who sought health services in the two weeks prior to the survey, 95.3% (95%CI 94.9–95.8) received care in their first visit. Percentages were higher in the following groups: 60 years of age and over; head of household with complete tertiary education; living in the South and Southeast regions. In addition, 82.5% (95%CI 81.2–83.7) of individuals who received health care and prescriptions were able to obtain all the necessary medicines, 1/3 of them from SUS. Less than half the Brazilian population (44.4%; 95%CI 43.8–45.1) visited a dentist in the 12 months prior to the survey, with smaller percentages among the following groups: 60 years of age or older; head of household with no education or up to incomplete elementary; living in the North region of Brazil.

CONCLUSIONS

People living in the South and Southeast regions still have greater access to health services, as do those whose head of household has a higher level of education. The (re)formulation of health policies to reduce disparities should consider differences encountered between regions and social levels.

Health Services, supply & distribution; Health Services Accessibility; Equity in Access; Socioeconomic Factors; Health Surveys

Indicator	Total	Age Group

		0–17		18–29		30–39		40–59		60 or over

	% 95CI%	%	95CI%	%	95CI%	%	95CI%	%	95CI%	%	95CI%
Did not perform normal activities for health reasons in the two weeks prior to the survey	7.0 6.8–7.2	5.6	5.2–5.9	4.6	4.2–4.9	6.0	5.6–6.4	8.7	8.3–9.1	11.5	10.8–12.2
Usually seeks the same facility, doctor or health service when in need of health care	77.8 77.0–78.6	79.9	79.0–80.9	75.6	74.6–76.7	76.4	75.3–77.5	77.3	76.4–78.3	79.3	78.2–80.4
Visited a doctor in the last 12 months	71.2 70.7–71.7	69.8	69.0–70.6	64.1	63.1–65.1	68.4	67.4–69.4	73.5	72.8–74.3	83.5	82.8–84.2
Visited a dentist in the last 12 months	44.4 43.8–45.1	45.2	44.3–46.1	51.0	50.1–52.0	50.4	49.3–51.5	42.9	41.9–43.9	28.9	27.6–30.1
Sought health care in the two weeks prior to the survey	15.3 15.0–15.7	11.9	11.3–12.4	11.4	10.9–12.0	13.7	13.0–14.4	18.0	17.4–18.6	25.0	24.0–25.9
... and received care in the first visit	95.3 94.9–95.8	95.7	94.9–96.5	94.0	92.8–95.1	94.9	93.8–95.9	95.1	94.3–95.8	96.6	95.8–97.3
... and received care	97.0 96.6–97.4	97.6	96.9–98.2	96.3	95.4–97.2	96.5	95.5–97.4	96.6	96.0–97.3	97.8	97.2–98.4
Received health care in the last two weeks, with prescribed medicines	64.8 63.8–65.9	69.2	67.2–71.3	59.8	57.4–62.3	61.1	58.7–63.5	64.1	62.3–65.9	67.3	65.2–69.4
Obtained all medicines prescribed in the last health care visit	82.5 81.2–83.7	81.6	79.1–84.1	84.0	81.7–86.4	81.5	79.0–84.0	82.7	81.0–84.5	82.6	80.3–84.8
Obtained at least one medicine prescribed in the last health care visit	92.4 91.7–93.1	91.3	89.7–92.8	93.1	91.7–94.4	90.0	88.1–91.8	92.7	91.5–93.9	94.4	93.2–95.5
Obtained at least one medicine prescribed in the last health care visit from the Popular Pharmacy Program	21.9 20.5–23.4	16.2	13.7–18.7	16.8	14.1–19.5	14.9	12.6–17.1	25.5	23.4–27.6	30.3	27.7–32.8
Obtained at least one medicine prescribed in the last health care visit from the public health system	33.2 31.6–34.7	32.4	29.5–35.3	29.2	26.1–32.2	28.6	25.7–31.5	34.4	32.0–36.8	37.4	34.5–40.2
Was hospitalized for 24 hours or more in the 12 months prior to the survey	6.0 5.8–6.3	4.5	4.2–4.8	5.5	5.1–5.8	5.9	5.5–6.4	6.0	5.6–6.4	10.2	9.6–10.9
... by the Brazilian Unified Health System (SUS) and ranked the service as good or very good	82.4 80.9–83.9	80.5	77.6–83.5	79.7	76.4–82.9	81.3	78.0–84.6	84.2	81.7–86.6	85.5	82.7–88.2
... and the last hospitalization was by the Brazilian Unified Health System (SUS)	65.7 63.8–67.5	75.2	72.3–78.1	69.7	66.3–73.2	58.8	54.8–62.7	62.7	59.2–66.2	61.8	58.2–65.4

Indicator	Total		Level of education of head of household

			No education or incomplete elementary		Complete elementary or incomplete secondary		Complete secondary or incomplete tertiary		Complete tertiary

	%	95CI%	%	95CI%	%	95CI%	%	95CI%	%	95CI%
Did not perform normal activities for health reasons in the two weeks prior to the survey	7.0	6.8–7.2	7.8	7.5–8.1	6.5	6.1–7.0	6.2	5.8–6.5	6.3	5.8–6.9
Usually seeks the same facility, doctor or health service when in need of health care	77.8	77.0–78.6	78.7	77.6–79.8	76.3	74.8–77.9	76.3	75.0–77.5	79.5	77.9–81.1
Visited a doctor in the last 12 months	71.2	70.7–71.7	67.1	66.4–67.9	70.8	69.6–71.9	74.3	73.5–75.2	81.0	79.9–82.2
Visited a dentist in the last 12 months	44.4	43.8–45.1	34.1	33.4–34.9	44.6	43.1–46.0	53.0	52.0–54.1	65.8	64.2–67.3
Sought health care in the two weeks prior to the survey	15.3	15.0–15.7	14.9	14.4–15.4	14.1	13.2–14.9	15.5	14.9–16.1	18.1	17.1–19.2
... and received care in the first visit	95.3	94.9–95.8	94.5	93.8–95.2	94.6	93.4–95.7	95.9	95.1–96.7	97.7	96.9–98.4
... and received care	97.0	96.6–97.4	96.4	95.7–97.0	96.4	95.5–97.4	97.5	96.8–98.2	98.8	98.3–99.4
Received health care in the last two weeks, with prescribed medicines	64.8	63.8–65.9	67.2	65.7–68.8	64.7	61.9–67.4	62.9	60.9–64.8	61.2	58.2–64.2
Obtained all medicines prescribed in the last health care visit	82.5	81.2–83.7	79.8	78.0–81.7	82.3	79.6–85.1	83.8	81.8–85.7	89.3	86.7–91.9
Obtained at least one medicine prescribed in the last health care visit	92.4	91.7–93.1	92.1	91.1–93.1	92.2	90.4–94.1	92.4	91.1–93.7	94.1	92.1–96.1
Obtained at least one medicine prescribed in the last health care visit from the Popular Pharmacy Program	21.9	20.5–23.4	26.5	24.3–28.6	21.9	18.7–25.1	19.5	17.3–21.8	10.8	8.4–13.2
Obtained at least one medicine prescribed in the last health care visit from the public health system	33.2	31.6–34.7	42.8	40.5–45.1	34.3	30.9–37.8	25.1	22.8–27.5	13.9	11.3–16.6
Was hospitalized for 24 hours or more in the 12 months prior to the survey	6.0	5.8–6.3	6.1	5.8–6.4	6.3	5.6–7.0	5.6	5.3–6.0	6.4	5.8–6.9
... by the Brazilian Unified Health System (SUS) and ranked the service as good or very good	82.4	80.9–83.9	83.3	81.6–85.1	81.6	77.4–85.9	81.0	78.1–83.9	78.1	70.7–85.6
... and the last hospitalization was by the Brazilian Unified Health System (SUS)	65.7	63.8–67.5	82.5	80.7–84.3	68.5	63.5–73.5	53.7	50.5–56.8	21.7	18.1–25.4

Indicator	Total	Macroregion

		North		Northeast		Southeast		South		Center-Wes

	% 95CI%	%	95CI%	%	95CI%	%	95CI%	%	95CI%	%	95CI%
Did not perform normal activities for health reasons in the two weeks prior to the survey	7.0 6.8–7.2	5.8	5.4–6.3	7.8	7.5–8.2	6.2	5.8–6.6	8.4	7.8–9.0	7.0	6.5–7.5
Usually seeks the same facility, doctor or health service when in need of health care	77.8 77.0–78.6	74.2	71.9–76.4	74.3	72.7–75.8	79.6	78.3–81.0	83.0	81.2–84.9	74.8	73.1–76.6
Visited a doctor in the last 12 months	71.2 70.7–71.7	61.4	59.9–62.9	66.3	65.5–67.2	75.8	74.8–76.8	73.8	72.6–74.9	69.5	68.4–70.6
Visited a dentist in the last 12 months	44.4 43.8–45.1	34.4	33.0–35.9	37.5	36.5–38.4	48.3	47.1–49.5	51.9	50.2–53.6	44.9	43.6–46.2
Sought health care in the two weeks prior to the survey	15.3 15.0–15.7	10.1	9.4–10.7	13.4	12.8–13.9	17.1	16.4–17.8	17.9	16.9–18.9	13.8	13.1–14.4
... and received care in the first visit	95.3 94.9–95.8	93.6	92.3–95.0	93.7	92.9–94.5	96.3	95.5–97.0	96.3	95.3–97.2	93.7	92.5–95.0
... and received care	97.0 96.6–97.4	95.6	94.4–96.8	95.8	95.1–96.5	97.4	96.8–98.1	98.2	97.6–98.8	96.4	95.5–97.2
Received health care in the last two weeks, with prescribed medicines	64.8 63.8–65.9	67.1	64.5–69.8	63.5	61.8–65.3	63.8	62.0–65.6	68.5	65.9–71.0	65.5	63.3–67.7
Obtained all medicines prescribed in the last health care visit	82.5 81.2–83.7	75.8	72.8–78.8	80.8	78.9–82.6	83.1	81.0–85.3	84.8	82.2–87.5	83.0	80.7–85.2
Obtained at least one medicine prescribed in the last health care visit	92.4 91.7–93.1	91.5	90.0–92.9	90.0	88.5–91.5	92.9	91.7–94.0	94.8	93.7–96.0	92.3	90.7–93.9
Obtained at least one medicine prescribed in the last health care visit from the Popular Pharmacy Program	21.9 20.5–23.4	20.3	17.2–23.3	16.4	14.3–18.4	23.7	21.2–26.1	26.5	22.8–30.2	18.9	16.2–21.6
Obtained at least one medicine prescribed in the last health care visit from the public health system	33.2 31.6–34.7	34.8	31.7–38.0	32.4	29.7–35.1	32.4	29.8–35.0	37.2	33.8–40.6	29.1	26.2–32.1
Was hospitalized for 24 hours or more in the 12 months prior to the survey	6.0 5.8–6.3	5.8	5.4–6.3	5.6	5.3–5.8	5.7	5.3–6.1	7.5	7.0–8.0	7.4	7.0–7.9
... by the Brazilian Unified Health System (SUS) and ranked the service as good or very good	82.4 80.9–83.9	68.5	63.9–73.2	79.8	77.5–82.1	87.1	84.3–89.9	85.2	81.8–88.5	80.8	77.7–83.8
... and the last hospitalization was by the Brazilian Unified Health System (SUS)	65.7 63.8–67.5	73.9	70.9–76.9	76.5	73.9–79.1	58.8	55.0–62.7	63.8	59.3–68.2	61.6	58.3–64.9

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[1] Correspondence: Sheila Rizzato Stopa. Departamento de Epidemiologia, FSP-USP. Av. Dr. Arnaldo, 715. 01246-904 São Paulo, SP, Brasil. E-mail: sheilarizzato@usp.br