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Desigualdades no acesso e utiliza??o dos servi?os de saúde na Regi?o Metropolitana de S?o Paulo
Pessoto,Umberto Catarino; Heimann,Luiza Sterman; Boaretto,Roberta Cristina; Castro,Iracema Ester do Nascimento; Kayano,Jorge; Ibanhes,Lauro Cesar; Junqueira,Virginia; Rocha,Jucilene Leite da; Barboza,Renato; Cortizo,Carlos Tato; Martins,Lourdes da Concei??o; Luiz,Olinda do Carmo;
Ciência & Saúde Coletiva , 2007, DOI: 10.1590/S1413-81232007000200011
Abstract: this paper presents case study findings in five municipalities in the s?o paulo metropolitan region. inequalities in access to health care services and their utilization were described through advanced tabulation data from the 1998 seade life conditions survey. the variables analyzed were: owning or not owning private health care insurance, income and age brackets. the health care service attributes studied were: health care services coverage by a health insurance plan, health services demands and average waiting time to receive health care. compared with other studies, using the 1998 ibge pnad, the results allowed us to confirm interregional imbalances which can only be detected in shorter special scale studies: the municipalities. despite showing the high private health insurances coverage the s?o paulo metropolitan region has a great inner heterogeneity. the inequalities in private health care insurance, access, waiting time, and type of insurance coverage were observed through income quintiles and age classes analyses. findings suggest that an expansion of the state's regulation capacity is necessary in order to empower the brazilian health care system principles of universality and equity to be qualified to offer brazilians the right to access health care services.
Gênero, morbidade, acesso e utiliza o de servi os de saúde no Brasil
Pinheiro Rejane Sobrino,Viacava Francisco,Travassos Cláudia,Brito Alexandre dos Santos
Ciência & Saúde Coletiva , 2002,
Abstract: O objetivo deste trabalho é analisar o perfil de morbidade referida, acesso e uso de servi os de saúde em homens e mulheres no Brasil, segundo idade e regi o urbana e rural. Os dados da PNAD/98 mostram que as diferen as de gênero na morbidade variam com a idade: desfavoráveis aos meninos até os 10 anos e desfavoráveis às mulheres a partir dos 15 anos, aumentando até os 64 anos e reduzindo após esta idade. A alta prevalência de atendimento indica que as barreiras de acesso dos que procuram servi os de saúde s o pequenas. No entanto, o elevado percentual de n o procura face às necessidades percebidas sugere que as barreiras de acesso s o anteriores e dependem da oferta. A cobertura por planos de saúde é bem maior na regi o urbana, mas n o há diferen as de gênero significantes nas regi es. As diferen as entre homens e mulheres nas taxas de uso curativo s o pequenas, se comparadas com as de uso preventivo, maiores para as mulheres, assim como as taxas de interna o, mesmo excluindo os partos. O financiamento das interna es n o foi diferente entre homens e mulheres, ao contrário do financiamento de outros tipos de atendimento: maior cobertura por planos para mulheres na regi o urbana; na regi o rural, maior uso do SUS para as mulheres e maior desembolso de recursos próprios para os homens.
Desigualdades no acesso e na utiliza??o de servi?os odontológicos no Brasil: análise do Sistema de Vigilancia de Fatores de Risco e Prote??o para Doen?as Cr?nicas por Inquérito Telef?nico (VIGITEL 2009)
Peres, Marco A.;Iser, Betine Pinto Moehlecke;Boing, Antonio Fernando;Yokota, Renata Tiene de Carvalho;Malta, Deborah Carvalho;Peres, Karen Glazer;
Cadernos de Saúde Pública , 2012, DOI: 10.1590/S0102-311X2012001300010
Abstract: this study aimed to evaluate access to and utilization of various types of dental services by individuals 18 years or older in brazil's state capitals. we gathered data from the telephone survey surveillance system for risk and protective factors for chronic diseases (vigitel) in 2009 (n = 54,367). more than half of the target population reported the need for dental treatment in the previous year; of these, 15.2% lacked access to dental services when needed. the private sector provided 61.1% of all dental appointments. the share of services provided by the unified national health system (sus) ranged from 6.2% in the federal district to 35.2% in boa vista, in the north. multivariate poisson regression models showed higher prevalence of dental treatment needs among women, middle-aged adults, and individuals with more schooling. lack of access to dental care was more frequent among women, young adults, less educated individuals, and among lightener-skinned blacks. our findings highlight sharp inequalities in the use of and access to dental services in the brazilian state capitals.
Desigualdades geográficas e sociais na utiliza??o de servi?os de saúde no Brasil
Travassos,Cláudia; Viacava,Francisco; Fernandes,Cristiano; Almeida,Célia Maria;
Ciência & Saúde Coletiva , 2000, DOI: 10.1590/S1413-81232000000100012
Abstract: health care service consumption is related not only to need and individuals' behavior, but also to factors associated to the supply side of health care market. the new brazilian constitution (1988) established the unified health care system (sus) which is based on universal access to health care services. the system was implemented in 1990. the principle of equity can be identified in the health sector legislation and can be translated as equal opportunity of access to equal needs. this study aimed at evaluating equity in the use of health care services considering two dimensions: geographical and social dimensions. data came from two general household surveys carried out in 1989 and 1996/1997 by the brazilian census bureau (ibge). standardized utilization rates controlled by morbidity and insurance coverage were used to analyze geographical variation. private expenditure with health insurance and drugs was also compared. logistic regression was used to test for social inequalities. results of the study suggest small reduction in inequalities between 1989 and 1996/1997, indicating that brazilian health care system remains highly unequal.
Gênero, morbidade, acesso e utiliza??o de servi?os de saúde no Brasil
Pinheiro,Rejane Sobrino; Viacava,Francisco; Travassos,Cláudia; Brito,Alexandre dos Santos;
Ciência & Saúde Coletiva , 2002, DOI: 10.1590/S1413-81232002000400007
Abstract: this paper analyses the profile of perceived morbidity, access and use of health services among men and women in brazil according to age and urban/rural situation. data from pnad/98 showed that gender differences in morbidity vary with age: unfavorable to boys up to 10 years old and to women after 15 years of age. differences rise with age up to age 64 and slow down after on. the high prevalence of attendance suggests that barriers for access for those who seek health care are small. nevertheless, the high percentage of people who did not seek health services among those who believe needed, indicates that access are important and dependent on the supply. the health plan coverage is greater among urban areas, but there is no significant gender differences within the areas. differences between women and men in acute care rates are low, compared with the preventive care rates, greater for women. inpatient rates were greater for women, even after excluding delivery. the financing of inpatient hospitalizations was not different between sexes, but there was a higher use of health plan for women in the urban sectors and higher use of the public health system (sus) for rural women and out of pocket payment for rural men.
Desigualdades no uso e acesso aos servi?os de saúde entre idosos do município de S?o Paulo
Louvison,Marília Cristina Prado; Lebr?o,Maria Lúcia; Duarte,Yeda Aparecida Oliveira; Santos,Jair Lício Ferreira; Malik,Ana Maria; Almeida,Eurivaldo Sampaio de;
Revista de Saúde Pública , 2008, DOI: 10.1590/S0034-89102008000400021
Abstract: objective: to describe factors associated to inequalities in access to health care services and utilization for the elderly. methods: study part of the health, well-being and aging in latin america and the caribbean ("sabe") survey that included 2,143 elderly individuals aged 60 or older in the city of s?o paulo, southeastern brazil, in 2000. a two-step sampling procedure with probability proportional to size was carried out using census tracts with replacement. to achieve the desired number of respondents aged 75 or older, additional households close to the selected census tracts were sampled. access to health services and utilization were measured for outpatient and hospital services during a 4-month period prior to the interview, and correlated to factors related to ability, need and predisposition (total income, schooling, health insurance, reported medical condition, self-perception, gender and age).multivariate logistic regression was performed in the analysis. results: of all respondents, 4.7% reported being hospitalized and 64.4% seeking outpatient care in the four months prior to the study. as for public outpatient care provided, 24.7% were in hospital clinics and 24.1% in other public outpatient services. as for private care, 14.5% received care in hospitals and 33.7% in health clinics. the multivariate analysis showed an association between health service utilization and sex, medical condition, self-perceived health, income, schooling, and health insurance. however, an inverse effect was found for the variable "schooling". conclusions: the study results show inequalities in access to health services and utilization as well as a deficient health care system. public policies should take into account the specific needs of the elderly population to facilitate access to health care services and reduce inequalities.
Redu??o das desigualdades sociais na utiliza??o de servi?os odontológicos no Brasil entre 1998 e 2008
Peres,Karen Glazer; Peres,Marco Aurélio; Boing,Antonio Fernando; Bertoldi,Andréa Damaso; Bastos,Jo?o Luiz; Barros,Aluisio J D;
Revista de Saúde Pública , 2012, DOI: 10.1590/S0034-89102012000200007
Abstract: objective: to analyze access to and utilization of dental care services in brazil. methods: we used data from the 2003 and 2008 brazilian national household surveys, which we compared to data from the 1998 survey. we investigated access and utilization variables at ages three, six, nine, 12, 15, and 19 years in the first (q1) and fifth (q5) quintiles of per capita family income. all analyses took into account the complex sampling strategy. results: the proportion of subjects that had never seen a dentist decreased during the period (18.7% in 1998, 15.9% in 2003 and 11.7% in 2008). there was an important reduction in the absolute difference in failure to use dental care services after age nine years between q1 and q5 from 1998 to 2008, which decreased to about half its value at 15 (30.3 percentage points - pp to 16.1 pp) and 19 years (20.4 pp to 9.9 pp). q5/q1 ratios for recent dental appointments fell across all age groups, especially between zero and six years (q5/q1 from 3.2 to 2.6); utilization of the national health care system for dental care increased in q1 and q5, with a reduction in the q1/q5 ratio of approximately 20%. use of the national health care system for dental care increased by approximately 8% in q1 and 35% in q5 between 2003 and 2008. conclusions: there have been considerable advances in terms of reducing inequalities in access to, and increasing the utilization of, dental care services in brazil between 1998 and 2008. however, inequality between social groups remains substantial.
Acessibilidade de indivíduos infectados pelo HIV aos servi os de saúde: uma revis o de literatura  [cached]
Acurcio Francisco de Assis,Guimar?es Mark Drew Crosland
Cadernos de Saúde Pública , 1996,
Abstract: Este trabalho tem por objetivo apresentar uma revis o de estudos que enfocam o tema da acessibilidade a a es e servi os de saúde. Tem-se demonstrado que indivíduos infectados pelo vírus da imunodeficiência humana (HIV) podem apresentar uma melhor sobrevida dependendo do tipo de acesso que tenham às a es e servi os de saúde, como, por exemplo, acesso a medicamentos profiláticos (por exemplo, zidovudina, pentamidina). Desta forma, o presente trabalho enfatiza e utiliza dados da epidemia do HIV como forma de abordar o tema proposto. O artigo inicia-se com uma exposi o do marco teórico sobre acessibilidade, seguida de uma revis o bibliográfica estruturada em quatro tópicos, a saber: 1) aspectos epidemiológicos da AIDS; 2) avalia o de qualidade dos servi os de saúde; 3) acessibilidade às a es e servi os de saúde e 4) estudos de acessibilidade em pacientes infectados pelo HIV. Considera es finais sobre o tema enfocado apontam para a necessidade de se compreender as implica es das diversas barreiras de acesso aos servi os, levando-se em conta os custos sociais e humanos da infec o pelo HIV, as necessidades e demandas dos indivíduos infectados e as conseqüências que o n o-atendimento em tempo hábil pode ter para estes indivíduos.
Uma revis?o sobre os conceitos de acesso e utiliza??o de servi?os de saúde
Travassos, Claudia;Martins, M?nica;
Cadernos de Saúde Pública , 2004, DOI: 10.1590/S0102-311X2004000800014
Abstract: the purposes of this article are to review the concepts of health services access and utilization and to analyze how these concepts interrelate. access is a complex concept (often used inaccurately) which changes over time and according to the context. health services utilization is at the core of health systems functioning. despite some disagreement, according to this review the prevailing perspective is that access is related to characteristics of services supply. health care services utilization can be applied as a measure of access, but use of services depends on other factors. individual and contextual factors influence the use of services. the article shows that the concept of access is becoming more comprehensive and is changing its focus from entry into the health system to outcome of care. access is valued in relation to its impact on health and depends on the effectiveness of care delivered. as an outcome measure, access becomes multidimensional and difficult to operationalize. finally, the article discusses how health determinants differ from those of health services utilization, which impacts directly on illness, but only indirectly on health.
Utiliza??o e acesso de idosos a servi?os de aten??o básica em Porto Alegre (RS, Brasil)
Paskulin,Lisiane Manganelli Girardi; Valer,Daiany Borghetti; Vianna,Lucila Amaral Carneiro;
Ciência & Saúde Coletiva , 2011, DOI: 10.1590/S1413-81232011000600031
Abstract: a cross-sectional study was carried out in the second semester of 2004 by means of a household survey with 292 elderly people in a southern brazilian city, selected by probabilistic sampling. the objectives were: to describe the use and geographic access of the elderly to primary healthcare (phc) in porto alegre (rs), and to analyze the association between variables of interest to the study and access to phc. descriptive and bivariate analysis was used. the primary health care services were used by 49.7% of the respondents, motivated by their location, quality and "free service." the factors negatively associated with the use of phc services were "level of education" and "perception of good health" and the variable related positively was "self-diagnosed chronic condition". the elderly exposed to frailty related with economic and health conditions were more likely to use phc, showing signs of equity in the health system. on the other hand, it is necessary to broaden the coverage to the elderly that do not have access, as well as implement healthcare strategies to meet the heterogenous demands of this age group.
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