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Income-Related Inequalities in Utilization of Health Services among Private Health Insurance Beneficiaries in Brazil.

机译：巴西私人健康保险受益人中与利用收入相关的医疗服务利用不平等。

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摘要

Background: Throughout the twentieth century, Brazil developed a Social Health Insurance, providing coverage to formal workers and their dependents. In 1988, the country implemented a health reform adopting a National Health Service model, based on three core principles, universal coverage, open-ended benefit package and striving for health equity. During this transition, formal workers recomposed their privileged access to healthcare through private health insurance, resulting in a two-tier system represented by those with dual coverage---public and private---and those who must rely exclusively on the public insurance. Private health insurance coverage has a positive correlation with income, however, between 1998 and 2008 private coverage expanded vigorously among the poor, while remained stable among the rich. The health equity literature in Brazil consistently reports the presence of relevant inequalities in utilization of health services favoring privately insured individuals. A gap in this literature, however, is to determine whether inequalities in utilization of health services remain among insured individuals, i.e., does private insurance improve access regardless of individuals' income?;Methods: The study relies on Andersen's behavioral model as a theoretical framework to analyze data from two rounds (1998 & 2008) of a national household survey, assessing levels of utilization of fourteen dependent variables across income quintiles and calculating concentration indexes as summary measures of inequality. Dependent variable distributions across income are standardized by need using the indirect method. Concentration curves compare the evolution of inequality during that time. Curve dominance is formally tested between survey years. 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 number of hospital admissions, the probability of having a hospitalization, and the number of hospital days during the last hospitalization. The latter two variables are broken down according to their financing source, either public (SUS) or private insurance.;Results: Physician services present very low inequalities, although a statistically significant positive gradient persists in both survey rounds. Poor PHI beneficiaries have an advantage compared to national levels. SUS financed hospitalizations are a rare phenomenon among privately insured individual but strongly concentrated on the poor. Poor PHI beneficiaries utilize private hospital at lower levels than the rich. Compared at a national level, they are at a disadvantage. In 1998, this was not the case, suggesting that insurers may be developing mechanisms to deter hospital utilization among the poor. Premium value and income are the most relevant contributors to inequality in physician and hospital services.;Conclusions: The Brazilian government (ANS) needs to monitor utilization levels across income and develop policies to increase accountability of PHI products particularly preventing insurers from purposefully pushing their beneficiaries to use SUS hospitals. Greater availability on insurance policies segmented as ambulatory care only and inpatient services only would increase the range of options for consumers that could sort more adequate coverage according to their capacity to pay and healthcare needs.
机译：背景：在整个20世纪，巴西开发了社会健康保险，为正规工人及其家属提供保险。 1988年，该国根据三项核心原则，即全民覆盖，开放式福利计划和争取健康平等，实施了采用国民健康服务模式的健康改革。在这一过渡期间，正式工作人员通过私人健康保险重新构成了他们享有医疗保健的特权，从而形成了一个由两层覆盖的人（公共和私人）和必须完全依靠公共保险的人代表的两级系统。私人健康保险的覆盖范围与收入呈正相关，但是，1998年至2008年之间，穷人的私人覆盖范围急剧扩大，而富人的范围则保持稳定。巴西的健康平等文献一致报告，在利用医疗服务方面存在着不平等现象，这种情况偏向私人保险个人。然而，该文献中的一个空白是要确定被保险人之间是否仍然存在医疗服务利用中的不平等现象，即私人保险是否会改善获得医疗服务的机会，而不论个人收入如何？；方法：该研究以安徒生的行为模型为理论框架来分析来自全国住户调查的两轮（1998年和2008年）的数据，评估收入五分位数对14个因变量的利用水平，并计算集中指数作为不平等程度的汇总指标。根据需要，可以使用间接方法标准化跨收入的因变量分布。浓度曲线比较了这段时间内不平等的演变。在调查年之间正式测试曲线优势。分解分析确定了导致不平等的最重要因素。医师服务被分析为有医师就诊的可能性和医师就诊的次数。分析医院服务，包括入院次数，住院的可能性以及上次住院期间的住院天数。后两个变量根据其融资来源（公共（SUS）或私人保险）细分。结果：尽管在两轮调查中均存在统计学上显着的正梯度，但是医师服务的不平等程度非常低。与国家层面相比，贫穷的PHI受益人具有优势。 SUS资助的住院治疗在私人参保的个人中很少见，但主要集中在贫困人口上。贫穷的PHI受益人使用私人医院的水平低于富有的人。与国家一级相比，它们处于劣势。 1998年情况并非如此，这表明保险公司可能正在开发一种机制来阻止穷人使用医院。保费价值和收入是导致医生和医院服务不平等的最主要因素。结论：巴西政府（ANS）需要监控整个收入的利用率，并制定政策以提高PHI产品的责任制，尤其是防止保险公司有意推销受益人使用SUS医院。细分为仅门诊护理和仅住院服务的保险单的可用性更高，将为消费者增加选择的范围，这些消费者可以根据其支付能力和医疗保健需求对更充分的承保范围进行分类。

著录项

  • 作者

    Werneck, Heitor.;

  • 作者单位

    The George Washington University.;

  • 授予单位 The George Washington University.;
  • 学科 Public health.;Health care management.;Public policy.
  • 学位 Dr.P.H.
  • 年度 2016
  • 页码 97 p.
  • 总页数 97
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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