Access to private health insurance in the metropolitan region of Manaus, AM, Brazil, in 2015: a cross-sectional population-based study

Costa Filho, Douglas Borges da; Galvão, Taís Freire; Kelles, Silvana Márcia Bruschi; Silva, Marcus Tolentino

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 29 (1) • 2020 • https://doi.org/10.5123/S1679-49742020000100001 copy

Access to private health insurance in the metropolitan region of Manaus, AM, Brazil, in 2015: a cross-sectional population-based study^* Authors’ contributions Galvão TF and Silva MT designed the study. Filho DBC and Silva MT analyzed and interpreted the data and drafted the preliminary versions of the manuscript. Galvão TF and Kelles SMB interpreted the data and undertook a relevant critical review of the intellectual content of the manuscript. All the authors have approved the final version and declare themselves to e responsible for all aspects of the work, ensuring its accuracy and integrity.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the frequency and factors associated with coverage by health insurance in the metropolitan region of Manaus, AM, Brazil.

Method:

a cross-sectional population-based study was conducted in 2015, with data collected through household interviews; prevalence ratios (PR) and confidence intervals (95%CI) were calculated using Poisson regression with robust variance adjusted for sex and age.

Results:

we interviewed 4,001 individuals; 13% (95%CI - 12.0;14.1%) had health insurance; greater insurance coverage was observed among military personnel (PR=3.18 - 95%CI 1.64;6.15), private sector employees (PR=1.91 - 95%CI 1.46;2.52) and public sector employees (PR=1.75 - 95%CI 1.23;2.49); health insurance was lower among poorer people (PR=0.21 - 95%CI 0.13;0.33), and those with less schooling (PR=0.66 - 95%CI 0.46;0.99).

Conclusion:

frequency of health insurance was low and was associated with better purchasing power, schooling, and employment.

Keywords:
Prepaid Health Plans; Health Services Accessibility; Quality of Health Care; Cross-Sectional Studies

Variables	Total		Health insurance coverage
Variables	N	%	N	%
Age range (in years)
18-24	838	20.9	109	12.8
25-34	1,152	28.8	135	11.7
35-44	843	21.1	131	15.5
45-59	772	19.3	105	13.6
≥60	396	9.9	43	10.8
Sex
Male	1,888	47.2	243	12.8
Female	2,113	52.8	280	13.2
Economic classification
A	34	0.9	17	50.1
B1	90	2.2	35	38.9
B2	505	12.6	112	22.1
C1	862	21.5	138	15.9
C2	1,423	35.6	155	10.8
D-E	1,087	27.1	66	6.1
Schooling
Higher education or above	158	4.0	49	30.8
High school education	1,903	47.5	304	15.9
Elementary school education	649	29.7	67	10.2
Below elementary school education	1,291	18.8	103	8.0
Ethnicity/skin color (self-reported)
White	636	15.9	104	16.3
Black	300	7.5	41	13.6
Yellow	138	3.5	16	11.5
Brown	2,886	72.2	357	12.3
Indigenous	41	1.0	5	12.0
State of health (self-reported)
Very good	471	11.9	57	12.0
Good	2,175	54.3	328	15.0
Regular	1,108	27.7	117	10.5
Poor	193	4.9	19	9.8
Very poor	54	1.4	2	3.7
Place of residence
Capital	3,479	86.9	452	13.0
Interior	522	13.2	71	13.2
Occupation
Does not work	577	14.4	63	11.2
Student	360	9.0	51	14.1
Retired	315	7.9	33	11.1
Domestic worker	45	1.1	2	4.4
Military personnel	12	0.3	7	58.3
Private sector employee	549	13.7	132	24.6
Public sector employee	164	4.1	50	30.2
Employer	36	0.9	8	22.3
Self-employed	1,104	27.7	81	7.4
Housewife	839	20.9	88	10.5
Other	41	1.0	8	19.5

Variables	Crude analysis		Adjusted analysis
Variables	PR ^a (95%CI^b)	P value ^c	PR ^a (95%CI^b)	P value ^c
Age range (in years) ^d
18-24	1.00	0.084	1.00	0.005
25-34	0.91 (0.72;1.16)		0.94 (0.74;1.20)
35-44	1.21 (0.95;1.53)		1.28 (0.99;1.64)
45-59	1.06 (0.83;1.36)		1.42 (1.08;1.85)
≥60	0.84 (0.6;1.17)		1.46 (0.98;2.19)
Sex ^e
Male	1.00	0.735	1.00	0.002
Female	1.03 (0.88;1.21)		1.33 (1.11;1.58)
Economic classification ^f
A	1.00	<0.001	1.00	<0.001
B1	0.78 (0.51;1.19)		0.89 (0.58;1.38)
B2	0.44 (0.30;0.64)		0.57 (0.38;0.84)
C1	0.32 (0.22;0.46)		0.45 (0.30;0.66)
C2	0.22 (0.15;0.31)		0.32 (0.22;0.48)
D-E	0.12 (0.08;0.18)		0.21 (0.13;0.33)
Schooling ^f
Higher education or above	1.00	<0.001	1.00	0.043
High school education	0.52 (0.40;0.67)		0.85 (0.64;1.12)
Middle school education	0.33 (0.24;0.46)		0.68 (0.47;0.97)
Below middle school education	0.26 (0.19;0.35)		0.66 (0.46;0.99)
Ethnicity/skin color (self-reported) ^f
White	1.00	0.108	1.00	0.474
Black	0.84 (0.60;1.17)		0.92 (0.67;1.28)
Yellow	0.71 (0.43;1.16)		0.78 (0.49;1.24)
Brown	0.76 (0.62;0.93)		0.84 (0.69;1.02)
Indigenous	0.74 (0.32;1.72)		0.82 (0.32;2.10)
State of health (self-reported) ^f
Very good	1.00	0.001	1.00	0.011
Good	1.25 (0.96;1.63)		1.32 (1.01;1.71)
Regular	0.88 (0.65;1.18)		1.00 (0.73;1.36)
Poor	0.81 (0.50;1.33)		0.97 (0.59;1.60)
Very poor	0.31 (0.02;1.23)		0.43 (0.11;1.76)
Place of residence ^f
Capital	1.00	0.894	1.00	0.743
Interior	1.02 (0.80;1.28)		1.04 (0.81;1.33)
Occupation ^f
Does not work	1.00	<0.001	1.00	<0.001
Student	1.27 (0.90;1.79)		1.16 (0.81;1.67)
Retired	0.95 (0.64;1.42)		0.96 (0.62;1.48)
Domestic worker	0.41 (0.10;1.63)		0.44 (0.11;1.74)
Military personnel	5.23 (3.07;8.91)		3.18 (1.64;6.15)
Private sector employee	2.19 (1.66;2.89)		1.91 (1.46;2.52)
Public sector employee	2.71 (1.95;3.76)		1.75 (1.23;2.49)
Employer	2.00 (1.04;3.84)		1.62 (0.87;3.02)
Self-employed	0.66 (0.48;0.90)		0.63 (0.46;0.86)
Housewife	0.94 (0.69;1.28)		0.89 (0.65;1.21)
Other	1.75 (0.90;3.41)		1.44 (0.75;2.77)

Variables	Frequency (%)
Health insurance rating
Very good	12.2
Good	58.0
Regular	22.1
Poor	3.8
Very poor	2.7
Never used	1.2
Health insurance duration
Up to 6 months	15.8
Between 6 months and 1 year	15.5
Between 1 and 2 years	11.7
More than 2 years	57.0

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Marcus Tolentino Silva - Universidade de Sorocaba, Programa de Pós-Graduação em Ciências Farmacêuticas, Rod. Raposo Tavares, km 92,5, Cidade Universitária Aldo Vanucchi, Sorocaba, SP, Brazil. Postcode: 18023-000. E-mail: marcusts@gmail.com