Louvison Marília Cristina Prado, Lebrão Maria Lúcia, Duarte Yeda Aparecida Oliveira, Santos Jair Lício Ferreira, Malik Ana Maria, Almeida Eurivaldo Sampaio de
Programa de Pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil.
Rev Saude Publica. 2008 Aug;42(4):733-40. doi: 10.1590/s0034-89102008000400021.
To describe factors associated to inequalities in access to health care services and utilization for the elderly.
Study part of the Health, Well-being and Aging in Latin America and the Caribbean ("SABE") Survey that included 2,143 elderly individuals aged 60 or older in the city of São Paulo, southeastern Brazil, in 2000. A two-step sampling procedure with probability proportional to size was carried out using census tracts with replacement. To achieve the desired number of respondents aged 75 or older, additional households close to the selected census tracts were sampled. Access to health services and utilization were measured for outpatient and hospital services during a 4-month period prior to the interview, and correlated to factors related to ability, need and predisposition (total income, schooling, health insurance, reported medical condition, self-perception, gender and age).Multivariate logistic regression was performed in the analysis.
Of all respondents, 4.7% reported being hospitalized and 64.4% seeking outpatient care in the four months prior to the study. As for public outpatient care provided, 24.7% were in hospital clinics and 24.1% in other public outpatient services. As for private care, 14.5% received care in hospitals and 33.7% in health clinics. The multivariate analysis showed an association between health service utilization and sex, medical condition, self-perceived health, income, schooling, and health insurance. However, an inverse effect was found for the variable "schooling".
The study results show inequalities in access to health services and utilization as well as a deficient health care system. Public policies should take into account the specific needs of the elderly population to facilitate access to health care services and reduce inequalities.
描述与老年人获得医疗保健服务及利用方面的不平等相关的因素。
该研究是拉丁美洲和加勒比地区健康、福祉与老龄化调查（“SABE”）的一部分，于2000年纳入了巴西东南部圣保罗市2143名60岁及以上的老年人。采用与规模成比例的概率两步抽样程序，对普查区进行有放回抽样。为了达到所需数量的75岁及以上受访者，对所选普查区附近的额外家庭进行了抽样。在访谈前的4个月期间，对门诊和住院服务的医疗服务可及性和利用情况进行了测量，并与能力、需求和倾向相关因素（总收入、受教育程度、健康保险、报告的医疗状况、自我认知、性别和年龄）进行关联。分析中进行了多变量逻辑回归。
在所有受访者中，4.7%报告在研究前四个月曾住院，64.4%寻求过门诊护理。至于提供的公共门诊护理，24.7%在医院诊所，24.1%在其他公共门诊服务机构。至于私人护理，14.5%在医院接受护理，33.7%在健康诊所接受护理。多变量分析显示，医疗服务利用与性别、医疗状况、自我感知健康、收入、受教育程度和健康保险之间存在关联。然而，发现变量“受教育程度”有相反的影响。
研究结果表明在获得医疗服务及利用方面存在不平等，以及医疗保健系统存在缺陷。公共政策应考虑老年人群体的特殊需求，以促进获得医疗保健服务并减少不平等。
