巴西医疗保健服务和药物未满足需求方面的不平等：分解分析
Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis.
作者信息
Coube Maíra, Nikoloski Zlatko, Mrejen Matías, Mossialos Elias
机构信息
Fundação Getúlio Vargas, São Paulo, Brazil.
Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil.
出版信息
Lancet Reg Health Am. 2023 Jan 13;19:100426. doi: 10.1016/j.lana.2022.100426. eCollection 2023 Mar.
BACKGROUND
Unmet need is a metric used to assess the performance of health care systems throughout the world. One of the primary objectives of the Brazilian health care system is to identify ways to improve the health outcomes of all citizens. To accomplish this challenging goal, the health care system in Brazil will need to identify and eliminate barriers and provide timely and adequate access to health care services to all.
METHODS
This study assessed the performance of the Brazilian health care system by focusing on the unmet need for health care services and medications. We evaluated the Brazilian National Health Survey data collected in 2013 and 2019 to determine the magnitude of socioeconomic-related inequalities associated with unmet health care needs. Primary contributing factors were identified via decomposition analysis of the calculated concentration indices (CInds).
FINDINGS
Despite the availability of universal health care, 3.8% and 7.5% of the population in Brazil reported unmet needs for health care services and medications, respectively in the 2019 survey. Although the overall unmet need for medications remained unchanged between 2013 and 2019, CInd analysis revealed significant pro-poor inequalities with respect to unmet needs for both health care services and medications. The overall magnitude of these inequalities was higher in the poorer regions of the country. The use of private health insurance as well as individual health and socioeconomic status contributed significantly to the inequalities associated with unmet needs for health care services and medication throughout Brazil.
INTERPRETATIONS
Policy interventions should focus on improving access to health care services, extending coverage to include pharmaceuticals, and targeting both financial and non-financial barriers to obtaining care, particularly those experienced by the poor and vulnerable populations in Brazil.
FUNDING
None.
背景
未满足的需求是用于评估全球医疗保健系统绩效的一项指标。巴西医疗保健系统的主要目标之一是找出改善所有公民健康状况的方法。为实现这一具有挑战性的目标，巴西的医疗保健系统需要识别并消除障碍，为所有人提供及时且充足的医疗保健服务。
方法
本研究通过关注医疗保健服务和药物的未满足需求来评估巴西医疗保健系统的绩效。我们评估了2013年和2019年收集的巴西全国健康调查数据，以确定与未满足的医疗保健需求相关的社会经济不平等程度。通过对计算得出的集中指数（CInds）进行分解分析来确定主要影响因素。
研究结果
尽管有全民医疗保健服务，但在2019年的调查中，巴西分别有3.8%和7.5%的人口报告存在未满足的医疗保健服务和药物需求。虽然2013年至
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