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巴西南部个体在 COVID-19 后对专科卫生服务使用的社会经济不平等。

Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil.

机构信息

Postgraduate Programme in Health sciences, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.

Postgraduate Programme in Public Health, Federal University of Rio Grande, Rio Grande, Rio Grande do Sul, Brazil.

出版信息

BMC Health Serv Res. 2023 May 25;23(1):542. doi: 10.1186/s12913-023-09476-7.

Abstract

BACKGROUND

Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil.

METHODS

This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package.

RESULTS

2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest.

CONCLUSIONS

There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.

摘要

背景

即使在大流行背景下,不平等的卫生服务使用证据对于公共政策的制定也很重要。本研究的目的是评估根据健康保险和收入,在巴西南部居住的个体感染 COVID-19 后,专门卫生服务使用的社会经济不平等情况。

方法

这是一项横断面电话调查,纳入了 2020 年 12 月至 2021 年 3 月间接受 RT-PCR 检测确诊为有症状 COVID-19 的年龄在 18 岁或以上的个体。调查问题包括感染 COVID-19 后是否前往卫生保健机构就诊、就诊的机构、健康保险和收入。不平等情况通过以下措施评估:不平等斜率指数(SII)和集中指数(CIX)。使用 Stata 16.1 统计软件包进行了调整后的分析,采用泊松回归分析,稳健方差调整。

结果

共访谈了 2919 人(合格人数的 76.4%)。其中,24.7%(95%CI 23.2; 36.3)至少使用过一项专门的卫生服务,20.3%(95%CI 18.9; 21.8)在诊断 COVID-19 后至少咨询过一次专科医生。有健康保险的个体更有可能使用专门的服务。与最贫困人群相比,最富裕人群使用专门服务的概率高达三倍。

结论

在巴西南部偏远地区,感染 COVID-19 后个体在专门服务的使用上存在社会经济不平等。有必要减少获得和使用专门服务的难度,并推广购买力转化为健康需求的逻辑。加强公共卫生系统对于保障民众的健康权利至关重要。

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