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巴西的公私医疗保健服务双重利用。

Dual Use of Public and Private Health Care Services in Brazil.

机构信息

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium.

Data Science Institute (DSI), I-BioStat, Hasselt University, BE-3500 Hasselt, Belgium.

出版信息

Int J Environ Res Public Health. 2022 Feb 6;19(3):1829. doi: 10.3390/ijerph19031829.


DOI:10.3390/ijerph19031829
PMID:35162852
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8835064/
Abstract

(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 ( = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users ( = 6484; 14.7%). Dual use happened both in the direction of public to private ( = 4628; 67.3%), and of private to public ( = 1855; 32.7%). Higher income had a significant effect on dual use ( < 0.0001), suggesting a dose-response relationship, even after controlling for confounders. Significant effects were also found for region ( < 0.0001) and usual source of care (USC) ( < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.

摘要

(1)背景:巴西拥有全民公共医疗保健系统,但个人仍可以选择购买私人健康保险和/或自费支付医疗费用。过去的研究表明,巴西人同时使用公共和私人服务,这可能导致双重成本。本研究旨在描述这种双重使用,并评估其与社会经济地位(SES)的关系。(2)方法:我们计算了调查加权的人口估计和描述性统计数据,并建立了一个调查加权的逻辑回归模型,以探索 SES 对医疗保健双重使用的影响,包括人口特征和其他与医疗保健需求和使用相关的变量,并将其作为额外的解释变量,使用 2019 年巴西国家健康调查的数据。(3)结果:在调查前两周内,估计有 39,039,016 人(= 46,914;18.6%)寻求医疗保健,其中 5,576,216 人是双重使用者(= 6484;14.7%)。双重使用既发生在公共到私人的方向(= 4628;67.3%),也发生在私人到公共的方向(= 1855;32.7%)。较高的收入对双重使用有显著影响(<0.0001),表明存在剂量-反应关系,即使在控制了混杂因素后也是如此。地区(<0.0001)和常规医疗服务来源(USC)(<0.0001)也有显著影响。(4)结论:大量巴西人正在从不同于其常规系统的来源寻求医疗保健。较高的 SES、地区和 USC 是相关因素,可能导致更多的健康不平等。由于其高患病率和重要影响,需要进行更多的研究来阐明双重使用的主要原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bac9/8835064/cd37ed5bcef1/ijerph-19-01829-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bac9/8835064/cd37ed5bcef1/ijerph-19-01829-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bac9/8835064/cd37ed5bcef1/ijerph-19-01829-g001.jpg

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本文引用的文献

[1]
What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study.

BMC Health Serv Res. 2022-1-10

[2]
The Family Health Strategy coverage in Brazil: what reveal the 2013 and 2019 National Health Surveys.

Cien Saude Colet. 2021

[3]
Health insurance coverage in Brazil: analyzing data from the National Health Survey, 2013 and 2019.

Cien Saude Colet. 2021

[4]
Changes in the pattern of health services use in Brazil between 2013 and 2019.

Cien Saude Colet. 2021

[5]
National Health Survey 2019: history, methods and perspectives.

Epidemiol Serv Saude. 2020

[6]
Tackling segmentation to advance universal health coverage: analysis of policy architectures of health care in Chile and Uruguay.

Int J Equity Health. 2020-7-15

[7]
Assessment of the medical expenditure of the basic health insurance in Morocco.

Pan Afr Med J. 2020-4-14

[8]
Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa.

BMC Public Health. 2020-3-4

[9]
When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance.

PLoS One. 2019-12-16

[10]
The relationship between private health plans and use of medical and dental health services in the Brazilian health system.

Cien Saude Colet. 2019-7-22

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