Características e fatores associados ao gasto privado em saúde com crianças da coorte BRISA

Abstract

The SUS is still unable to serve the entire population, which is attributed to inequalities in quality of care and access restrictions, in addition to the financing structure of in the country. In Brazil private spending on health is higher than public spending, diverging of all systems of universal character in the world. The objectives of this study were to compare the characteristics of direct spending of families with children's health in São Luís / MA and Ribeirão Black / SP, and to analyze the factors associated with this expenditure in children between 13 and 35 months São Luís / MA. Two articles were prepared. The first is a cross-sectional study using data from the BRISA cohort in Ribeirão Preto (n = 3015 children) and in São Luís (n = 3247 children). Medications, consultations and examinations were the components of private spending studied. The magnitude (high expenditure / low expenditure) and nature of expenditure (frequency of combinations of spending with the three items, and bivariate analysis of expenditure items by income level family and type of health service coverage. In order to compare the cities, the Confidence Intervals (95%). In São Luís it was estimated that 45.7% of high expenditure (95% CI: 43.9 - 47.4) and in Ribeirão Preto 13.8% (95% CI: 12.5 - 15.0). Spending on drug is the most prevalent in the two cities - São Luís, 94.2% (95% CI: 95% CI: 93.4% 95.0); and Ribeirão Preto 87.8% (95% CI: 86.7-89.1). The most frequent combination of components was examination / medication (23.3%; 95% CI: 21.8-24.2) in São Luís, and in Ribeirão Black was consultation / medication (11.7%; 95% CI: 10.4-12.7). Spending on medication predominated in all income brackets in the two cities. Among the children covered by the plan of health, in São Luís 97.7% (95% CI: 96.5 - 98.6) reported spending on medication; 29.3% (95% CI: 26.3 - 32.5) with consultation; and 24.7% (95% CI: 21.9 - 27.7) with exams. In Ribeirão Black for the same components was 94.6% (95% CI: 93.4-95.6), 16.1% (95% CI: 14.3-18.0) and 7.4% (95% CI: 6.2-8.8), respectively. In São Luís, 95.2% (95% CI: 93.2 - 96.7) of the children covered by the ESF demanded of families spent on medicines; 39.9% (95% CI: 36.0 - 43.8) with exams; and 27.5% (95% CI: 24.0 - 31.1) with consultation. In (95% CI: 80.5 - 88.4), 6.1% (95% CI: 3.8 - 9.2) and 10.4% (95% CI: 7.4 - 14.2), respectively. In the second article, a longitudinal using data from the BRISA cohort with a final sample of 3247 children. Multivariate regression was performed - Poisson model, with inclusion of the variables of mode hierarchical, according to the previously defined theoretical model. The outcome was the spending on medicines, consultations and examinations, categorized as high spending (with 2 or 3 components) and low expenditure (with 1 component). Factors associated with risk to expenditure high were: higher levels of mother's education (PR = 1.67, 95% CI: 1.34-2.07, and PR = 1.52; 95% IC: 1.13 - 2.02; p <0.001), not private coverage (PR = 1.49, 95% CI: 1.23 - 1.81; and p = 0.001), prenatal care in private service (PR = 1.47, 95% CI 1.07-2.02, and p = 0.01), children older than 24 months (RP = 1.33, 95% CI: 1.06 - 1.68, and p = 0.01), and poor / regular child health (PR = 1.23, 95% CI 1.03 - 1.48, and p = 0.02). Breastfeeding time maternal age from 12 to 24 months (RP = 0.82, 95% CI: 0.67 - 0.99, and p = 0.04). protective at high expense. It is demanded to increase the offer / access to pharmaceutical children; assess child care in the FHS; breastfeeding for more than 12 months; and understand the role of health plans in private spending and access to health. demonstrate significant differences in private spending on child health among cities, suggesting that in São Luís there is less access to consultations and examinations, and families may be more subject to financial risks derived from these expenses.