Measuring and Explaining Income-Related Inequalities and Inequities in Healthcare Utilization: Evidence from Brazil Open Access
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Background: The pursuit of equity in health and healthcare has been placed high on the public policy agenda of the Brazilian government. Since the amendment of the Federal Constitution in 1988 and the inception of the Brazilian Unified Health System (SUS) in 1989, a number of policies and programs have been established to promote equity in healthcare. While the Brazilian health system continues to strive to provide healthcare to all, evidence to the extend that the health system has achieved equity in access and utilization of healthcare services still inconclusive. The objective of this study is to assess income-related inequalities in healthcare utilization in the Brazilian health system and their contributing factors.Methods: This study uses data from a nationally representative cross-sectional survey, the 2003 Brazilian national household survey (PNAD), to investigate inequalities and inequities in healthcare utilization for medical, dental and hospital care using physician visits, dentist visits, and inpatient days. All health care utilization variables were standardized for need differences using age, sex and health status as proxies for healthcare need. Concentration indices of the unstandardized distribution of healthcare utilization were used to measure inequality in healthcare utilization. Horizontal inequity of healthcare services was measured using concentration indices of the need-standardized use. Results: The findings of this study reveal that, given the same need, higher income groups seek more care from physicians and dentists and are more intense users of medical, dental and hospital services than lower income groups. The only exception is for the probability of hospitalization, in which lower income groups tend to seek more hospital services, albeit higher income groups are more intense users of this type of service. Private health insurance, education, income, and geographic region were the major contributors to the inequalities found in healthcare utilization. Conclusion: This study suggests that horizontal inequity in the utilization of healthcare services in Brazil exist and is often pro-rich.