Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)
Poster Number
29
Document Type
Poster
Keywords
Health Equity; Health Inequality; Health Insurance; Brazil
Publication Date
3-2016
Abstract
Brazil’s 1988 health reform created the Unified Health System (SUS). SUS is a universal health system that emulates British National Health Service, featuring an open-ended benefit package and a major goal of health equity. An unforeseen consequence of the reform was that former beneficiaries of the social health insurance sought to sustain their privileged access to health services through private health insurance. Despite achievements in expanding healthcare access and improved health outcomes, recurring opinion polls suggest that Brazilians are skeptical about SUS’ capacity to delivery timely and quality health services, making private insurance a priority to most households. The literature that focuses on health equity in Brazil strongly suggests that inequalities in utilization of health services exist between private insured and uninsured (SUS-dependent) individuals. No research exists, however, on whether inequalities in utilization of health services remain among privately insured individuals. In this study, therefore, we ask whether private coverage actually improves healthcare access, regardless of beneficiaries’ income? The study uses Andersen’s behavioral model as a theoretical framework to analyze data from two rounds (1998 and 2008) of a national household survey. We assess fourteen dependent measures that reflect utilization across income quintiles. We then calculate concentration indexes as summary measures of inequality. Concentration curves compare the evolution of inequality over time. Decomposition analysis identifies the most relevant contributors to inequality. Physician services are analyzed as the probability of having a physician visit and the number of physician visits. Hospital services are analyzed as the probability of having a hospitalization, the number of hospital days during the last hospitalization, and the number of hospital admissions. The former two variables are broken down according to their financing source, either public (SUS) or private insurance. We find very little inequality in levels of physician services utilization, although a statistically significant positive gradient persists in both survey rounds. SUS financed hospitalizations are rare among privately insured individual, but strongly concentrated among the poor. Most hospitalizations among the study group are funded thought private insurance, and they are highly concentrated among the rich. Premium rates and income are the most relevant contributors to inequality. We find that private health insurance increases utilization levels of physician services, providing comparable access across income groups. However, we also find that private coverage does not guarantee that poor beneficiaries will have access to hospital services. Private insurance with low premiums that serve the poor should focus solely on ambulatory care.
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(VIDEO) Income-Related Inequalities in Utilization of Health Services Among Private Health Insurance Beneficiaries in Brazil
Brazil’s 1988 health reform created the Unified Health System (SUS). SUS is a universal health system that emulates British National Health Service, featuring an open-ended benefit package and a major goal of health equity. An unforeseen consequence of the reform was that former beneficiaries of the social health insurance sought to sustain their privileged access to health services through private health insurance. Despite achievements in expanding healthcare access and improved health outcomes, recurring opinion polls suggest that Brazilians are skeptical about SUS’ capacity to delivery timely and quality health services, making private insurance a priority to most households. The literature that focuses on health equity in Brazil strongly suggests that inequalities in utilization of health services exist between private insured and uninsured (SUS-dependent) individuals. No research exists, however, on whether inequalities in utilization of health services remain among privately insured individuals. In this study, therefore, we ask whether private coverage actually improves healthcare access, regardless of beneficiaries’ income? The study uses Andersen’s behavioral model as a theoretical framework to analyze data from two rounds (1998 and 2008) of a national household survey. We assess fourteen dependent measures that reflect utilization across income quintiles. We then calculate concentration indexes as summary measures of inequality. Concentration curves compare the evolution of inequality over time. Decomposition analysis identifies the most relevant contributors to inequality. Physician services are analyzed as the probability of having a physician visit and the number of physician visits. Hospital services are analyzed as the probability of having a hospitalization, the number of hospital days during the last hospitalization, and the number of hospital admissions. The former two variables are broken down according to their financing source, either public (SUS) or private insurance. We find very little inequality in levels of physician services utilization, although a statistically significant positive gradient persists in both survey rounds. SUS financed hospitalizations are rare among privately insured individual, but strongly concentrated among the poor. Most hospitalizations among the study group are funded thought private insurance, and they are highly concentrated among the rich. Premium rates and income are the most relevant contributors to inequality. We find that private health insurance increases utilization levels of physician services, providing comparable access across income groups. However, we also find that private coverage does not guarantee that poor beneficiaries will have access to hospital services. Private insurance with low premiums that serve the poor should focus solely on ambulatory care.
Comments
Presented at: GW Research Days 2016.