Freitas Bruna Leão, Antiga Maria Luisa de Oliveira Collino, Sarti Flavia Mori
School of Arts, Sciences and Humanities, University of São Paulo, São Paulo 03828-000, Brazil.
J Mark Access Health Policy. 2025 May 9;13(2):21. doi: 10.3390/jmahp13020021. eCollection 2025 Jun.
Advances in primary healthcare coverage for the improvement in health outcomes at the population level comprise a major goal of public policies of health, particularly considering increases in hospitalization costs linked to chronic diseases in recent decades. Previous evidence shows the positive effects of access to primary healthcare on hospitalization indicators in high-income countries; however, there is a lack of literature on the subject in Latin American countries. Thus, the present study proposes a quantitative investigation on connections between primary healthcare quality and effectiveness in relation to hospitalization indicators, in addition to the identification of its effects on inequalities in hospitalizations in Brazil. The study was based on an empirical analysis of data from five cross-sectional surveys representative at the population level conducted by the Brazilian Institute for Geography and Statistics (IBGE) in 1998, 2003, 2008, 2013, and 2019. Information on the demographic, socioeconomic, and health characteristics of individuals compatible across surveys were included in the analyses, in addition to data on household and survey characteristics. The statistical analyses were based on the estimation of logistic regression models for the exploration of effects of primary healthcare quality and effectiveness on hospitalizations, inpatient days, and perception of quality of hospital care. Furthermore, the estimation of concentration indexes and their disaggregation allowed to verify trends and determinants of inequalities in hospitalization indicators in Brazil throughout the period. The results indicate that primary healthcare effectiveness is associated with the lower occurrence and frequency of hospitalizations, and a lower length of stay in hospitals. Primary healthcare quality was associated with the perception of higher quality of hospital care. Trends in hospitalization indicators showed reduction in inequalities towards low-income individuals from 1998 to 2013, and primary healthcare quality presented minor influence on inequalities in hospitalizations, inpatient days, and perception of quality of hospital care.
在人群层面上，通过扩大初级医疗保健覆盖范围来改善健康状况，是卫生公共政策的一个主要目标，尤其是考虑到近几十年来与慢性病相关的住院费用不断增加。先前的证据表明，在高收入国家，获得初级医疗保健对住院指标有积极影响；然而，拉丁美洲国家在这方面缺乏相关文献。因此，本研究除了要确定初级医疗保健质量和有效性对巴西住院不平等现象的影响之外，还提议对初级医疗保健质量和有效性与住院指标之间的联系进行定量调查。该研究基于对巴西地理与统计研究所（IBGE）在1998年、2003年、2008年、2013年和2019年进行的五项具有全国代表性的横断面调查数据的实证分析。分析中纳入了各次调查中一致的个人人口统计学、社会经济和健康特征信息，以及家庭和调查特征数据。统计分析基于逻辑回归模型的估计，以探究初级医疗保健质量和有效性对住院、住院天数以及对医院护理质量感知的影响。此外，通过估计集中指数并对其进行分解，可以验证该时期巴西住院指标不平等现象的趋势和决定因素。结果表明，初级医疗保健的有效性与较低的住院发生率和频率以及较短的住院时间相关。初级医疗保健质量与对更高质量医院护理的感知相关。住院指标的趋势显示，从1998年到2013年，针对低收入人群的不平等现象有所减少，并且初级医疗保健质量对住院、住院天数以及对医院护理质量感知方面的不平等影响较小。
