Proadess - Avaliação do Desempenho do Sistema de Saúde

Biblioteca (Todos)

Lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil

Is Health Related Quality of Life (HRQoL) a valid indicator for health systems evaluation?

Institutional and Economic Determinants of Public Health System Performance

Inequities in healthcare utilization: results of the Brazilian National Health Survey, 2013

AUTOR(ES): Boccolini, Cristiano Siqueira; Borges, Paulo Roberto.

ANO: 2016

RESUMO: Background: The Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil. Methods: We employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %). Results: 0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class "E" (AOR = 6.31, 95 % CI = 3.76-10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78-5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30-3.74), males (AOR = 2.16, 95 % CI = 1.99-2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83-2.44). Individuals self-classified as "white" were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75-0.90). Conclusions: Despite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.

FONTE:

REFERENCIA: Boccolini and de Souza Junior The official journal of the International Society for Equity in Health (2016) 15:150. DOI 10.1186/s12939-016-0444-3.

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Inequalities in health: de?nitions, concepts, and theories

Inequalities in health in Scotland: what are they and what can we do about them?

Inequalities in access to medical care by income in developed countries

AUTOR(ES): Van Doorslaer, E., Masseria, C., Koolman, X., & for the OECD Health Equity Research Group.

ANO: 2006

RESUMO: Background: Most of the member countries of the Organization for Economic Cooperation and Development (OECD) aim to ensure equitable access to health care. This is often interpreted as requiring that care be available on the basis of need and not willingness or ability to pay. We sought to examine equity in physician utilization in 21 OECD countries for the year 2000. Methods: Using data from national surveys or from the European Community Household Panel, we extracted the number of visits to a general practitioner or medical specialist over the previous 12 months. Visits were standardized for need differences using age, sex and reported health levels as proxies. We measured inequity in doctor utilization by income using concentration indices of the need-standardized use. Results: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland. Interpretation: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

FONTE:

REFERENCIA: Van Doorslaer, Eddy et al. "Inequalities in Access to Medical Care by Income in Developed Countries." CMAJ: Canadian Medical Association Journal, 174.2 (2006): 177-183.

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Indicadores de desempenho no Sistema Único de Saúde: uma avaliação dos avanços e lacunas

Improved Health System performance throught better care coordination

Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data

AUTOR(ES): Rasella Davide, Harhay Michael O, Pamponet Marina L, Aquino Rosana, Barreto Mauricio L

ANO: 2014

RESUMO: Objectives: To evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009. Design: Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications. Setting: Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009. Data sources: 1622 Brazilian municipalities with vital statistics of adequate quality. Main outcome measures: The annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (?70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period. Results: FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. Conclusions: Comprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.

FONTE:

REFERENCIA: Rasella Davide, Harhay Michael O, Pamponet Marina L, Aquino Rosana, Barreto Mauricio L. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data BMJ 2014; 349 :g4014.

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How close have universal health systems come to achieving equity in use of curative services? A systematic review.

Health, United States, 2007: With Chartbook on Trends in the Health of Americans

Health Systems Institucional Characteristcs: a survey of 29 OECD countries

Health System snapshots: perspectives from six countries

Health System Assessment Approach: A How-To Manual Version 3.0

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