James Macinko|Maria Fernanda Lima?Costa
Horizontal equity in health care utilization in Brazil, 1998–2008
New York University|Fundação Oswaldo Cruz|Universidade Federal de Minas Gerais
study assesses trends horizontal equity utilization healthcare services 1998 2008a period major economic social change brazildata nationally representative surveys repeated 1998 2003 2008 apply established methods assessing horizontal inequity healthcare access principle people healthcare needs similar access healthcare services horizontal inequity calculated difference observed healthcare utilization utilization predicted healthcare needs outcomes examined include probability medical dental hospital visit past 12 months health service use past two weeks usual source healthcare use monthly family income measure differences socioeconomic position healthcare needs include age sex selfrated health chronic conditions nonneed factors include income education geography health insurance family health strategy coveragethe probability least one doctor visit past 12 months became substantially equitable time ending slightly prorich orientation 2008 hospitalization past 12 months found propoor periods became slightly less 2008 dental visits showed largest absolute decrease horizontal inequity although still inequitably prorich distributed outcome 2008 service use past two weeks showed decreased inequity 2003 exhibited significant change 2003 2008 usual source care became less prorich time nearly incomeneutral 2008 factors associated greater inequities include income private health plan geographic location factors associated greater equity included health needs schooling enrolment family health strategyhealthcare utilization brazil appears become increasingly equitable past 10 years although imply equity health outcomes improved correspondingly suggest government policies aimed increasing access especially primary care helped make healthcare utilization brazil fairer time