Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil

Wendt, Andrea; Marmitt, Luana Patrícia; Nunes, Bruno P.; Dumith, Samuel C.; Crochemore-Silva, Inácio

doi:10.1590/1413-81232022272.03052021

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FREE THEMES • Ciênc. saúde coletiva 27 (02) • Feb 2022 • https://doi.org/10.1590/1413-81232022272.03052021 copy

Socioeconomic inequalities in the access to health services: a population-based study in Southern Brazil

Desigualdades socioeconômicas no acesso aos serviços de saúde: um estudo de base populacional no sul do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to measure socioeconomic inequalities regarding access to health services, contact with health professionals, and specific health interventions. This was a cross-sectional population-based study with individuals aged 18 years or older, living in the city of Rio Grande. The outcomes were the following: Family Health Strategy (FHS) coverage; having a health insurance plan; receiving a visit of a community health worker; medical consultation; dental consultation; dietary counseling; having a class with a physical education professional; flu vaccination; mammography, cytopathological and prostate exams. Relative and absolute measures were used to assess inequalities in the distribution of the outcomes. There was a response rate of 91% (1,300 adults were interviewed). Coverage indicators ranged from 16.1%, for having a class with a physical education professional, to 80.0% for medical consultation. FHS coverage and visit of a community health agent presented higher proportions among the poorest while outcomes regarding contact with health professionals, screening exams and flu vaccine were more prevalent among richest group. We observed low coverage levels of access to health services and professionals in addition to marked socioeconomic inequalities.

Key words:
Health services; Health inequalities; Socio-economic

Indicators	Definition
Health services characteristics	Family Health Strategy registration	Household being registered in the Family Health Strategy program	Is your household registered in the Family Health Strategy?
	Visit of community health agent	Receive a visit of a community health worker in the previous 12 months	Have you received a visit from a community health agent or a member of the Family Health team since last year?
	Private health insurance	Private health insurance	Do you have a private health plan?
Contact with health professional	Dental consultation	Having a dentist consultation in the last six months	When was the last time you went to the dentist?
	Medical consultation	Having a medical consultation in the last 12 months	When was the last time you saw a physician?
	Dietary counselling	Having a dietary counseling in the previous year	Have you received any recommendations on eating habits since last year?
	Class with physical education professional	Having class with physical educator in the last three months	Have you had a class with a physical education professional in the previous three months?
Screening and vaccine	Cytopathologic exam	At least one cytopathologic exam in the previous three years (for women aged 25 to 64 years old)	Have you ever done a uterine cancer screening? How long ago?
	Flu vaccine	Flu vaccine in the previous 12 months	Have you taken the flu vaccine shot this year? Did you take it last year?
	Mammography exam	At least one mammography exam in the previous two years (for women aged 50 to 69 years old)	Have you ever done a mammogram? How long ago?
	Prostate exam	At least one prostate exam at any time (for men aged 45 years old or more)	O Sr. já fez exame de próstata, toque retal ou PSA? Have you ever done a prostate exam?
Stratifier	Definition
Familiar income	Amount received by all family members in the previous month divided in quartiles. First quartile represents the poorest group and the fourth, the richest
Wealth index	Take in account characteristics from household (source of drinking water, number of dormitories and number of toilets) and a list of assets (TV, computer, car, internet, telephone, etc). A principal component analysis was carried out and the first component resulting was divided into quartiles. First quartile represents the poorest group and the fourth, the richest
Education	Completed years of scholarship

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

SC Dumith and I Crochemore-Silva conceived and designed the analysis; SC Dumith collected the data; A Wendt and LP Marmitt performed the analysis. A Wendt, LP Marmitt, SC Dumith, I Crochemore-Silva and BP Nunes wrote the paper, carried a critical review, and approved the final version.