Guttier Marília Cruz, Tejada Cesar Augusto Oviedo, Wehrmeister Fernando C, Silveira Mariângela Freitas, Domingues Marlos R, Barros Aluísio J D, Santos Iná S, Matijasevich Alícia, Bassani Diego G, Bertoldi Andréa Dâmaso
Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
Programa de Pós-graduação em Organizações e Mercados, Universidade Federal de Pelotas, Pelotas, Brazil.
Cad Saude Publica. 2020;36(7):e00120019. doi: 10.1590/0102-311x00120019. Epub 2020 Jul 3.
Although most childbirth care in Brazil is financed by the Brazilian Unified National Health System (SUS), there are out-of-pocket expenditures (private personal costs) involved in births. This study aims to compare maternal out-of-pocket expenditures in births of children from the Pelotas Birth Cohorts of 2004 and 2015. The study drew on information collected right after birth and at three months of age. The target variables include sociodemographic and economic data, private health plan coverage, and expenditures related to the birth. Values from 2004 were adjusted to 2015 by the general price index. There was an increase in private health plan coverage from 33.4% (95%CI: 31.9-34.9) to 45.1% (95%IC: 43.6-46.7) in the target period, directly associated with the families' socioeconomic status (p < 0.001). There was an increase in mean expenditures on hospitalization for the birth, from BRL 60.38 (SD = 288.66) to BRL 171.15 (SD = 957.07), and in additional medical expenditures, from BRL 191.60 (SD = 612.86) to BRL 1,424.80 (SD = 4,459.16) among mothers admitted to hospital under their private health plans (and there was no significant difference in these expenditures for mothers that opted for direct payment). There was an important increase in expenditures for childbirth care, especially among mothers admitted to hospital under private health plans.
尽管巴西的大多数分娩护理由巴西统一国家卫生系统（SUS）提供资金支持，但分娩过程中仍存在自付费用（个人私人成本）。本研究旨在比较2004年和2015年佩洛塔斯出生队列中儿童出生时母亲的自付费用。该研究利用了出生后及三个月大时收集的信息。目标变量包括社会人口统计学和经济数据、私人健康保险覆盖情况以及与分娩相关的费用。2004年的值通过一般物价指数调整至2015年。在目标时期内，私人健康保险覆盖率从33.4%（95%CI：31.9 - 34.9）增至45.1%（95%IC：43.6 - 46.7），这与家庭的社会经济地位直接相关（p < 0.001）。在私立健康保险计划下住院分娩的母亲，其住院分娩平均费用从60.38雷亚尔（标准差 = 288.66）增至171.15雷亚尔（标准差 = 957.07），额外医疗费用从191.60雷亚尔（标准差 = 612.86）增至1424.80雷亚尔（标准差 = 4459.16）（而选择直接付费的母亲在这些费用上无显著差异）。分娩护理费用有显著增加，尤其是在私立健康保险计划下住院的母亲中。
