Irene Garcia-Subirats1, Ingrid Vargas Lorenzo2, Amparo Susana Mogollón-Pérez3, Pierre De Paepe4, Maria Rejane Ferreira da Silva5, Jean Pierre Unger4, María Luisa Vázquez Navarrete2. 1. Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España; Programa de doctorado en Biomedicina, Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España. Electronic address: igarcia@consorci.org. 2. Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España. 3. Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia. 4. The Prince Leopold Institute of Tropical Medicine, Antwerpen, Bélgica. 5. Faculdade de Enfermagem, Universidade de Pernambuco, Recife, Brazil; FIOCRUZ/PE, Recife, Brazil.
Abstract
OBJECTIVE: To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. METHODS: A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n=2163) and two in Brazil (n=2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. RESULTS: The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. CONCLUSIONS: In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.
OBJECTIVE: To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. METHODS: A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n=2163) and two in Brazil (n=2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. RESULTS: The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. CONCLUSIONS: In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.
Authors: Ingrid Vargas; Amparo Susana Mogollón-Pérez; Pierre De Paepe; Maria Rejane Ferreira da Silva; Jean Pierre Unger; María Luisa Vázquez Journal: BMC Health Serv Res Date: 2015-05-29 Impact factor: 2.655
Authors: Ingrid Vargas; Amparo Susana Mogollón-Pérez; Pierre De Paepe; Maria Rejane Ferreira da Silva; Jean-Pierre Unger; María-Luisa Vázquez Journal: Health Policy Plan Date: 2016-02-13 Impact factor: 3.344