Avaliação da eqüidade no uso de serviços de saúde de uma população brasileira em idade laboral: o Estudo Pró-Saúde

Abstract

Studies of equity in health services use are important tools in helping the development of policies to ultimately maintain and improve people's health. ln brazilian population, social inequality in health services use in favor of individuais with major income and educational leveis was observed, on the basis of data from the National Research for Sample of Domiciles (PNAD). These type of studies in economically active populations are scarce, although they account for a great part of the national production. Objective: To evaluate equity in use of health care services, according to educational levels, in a population of workers who referred restriction of daily activities. Met/,ods: Cross-sectional study, using data from a prospective cohort, initiated in 1999, of civil servants at a brazilian public university in Rio de Janeiro, the Pro-Saude Study. Participants were 767 individuais who referred restriction of daily activities because of health problems in the 15 days preceding the second interview at 2001. Use was evaluated using a proxy variable defined by the decision of searching a health service and the type of health service searched. Additional variations in morbidity were verified by the reasons that caused the restriction and the restriction time, which was considered in this study a severity marker for need. The social indicator chosen was educational level. Analyses were stratified by sex and adjusted by age. Results: After the adjustment for age, the percentage ratios ofhealth services use were 81,1 (CI 95%: 68,9-89,3) and 70,8 (CI 95%: 60,6-79,3) for the lowest and highest educational levels in men, and were 83,0 (CI 95%: 71,9-90,3) and 69,5 (CI 95%: 63,2-75,2) for the lowest and highest educational leveis in women, respectively. The frequency of doctor's office use increased and the frequency of hospital use decreased with the increase in education. ln relation to restriction causes, it was observed an increase in frequency of neurological and respiratory reasons, and a reduction of muscle-skeletal and cardiological system reasons, with the increase in educational leveis. Restriction time presented inverse association with educational levels. Discussion: A standard of social inequality in health services use in favor of individuais with minor educational leveis, which was inverse to the observed in brazilian population, even after controlling for need variables, was verified. For this reason, the remaining differences in morbidity do not appear enough to explain this finding. The presence of some occupational factors, as the need for doctor's statement among individuais with minor educational levels, must exert greater influence in this specific population ofworkers.