Lack of access and the trajectory of healthcare use by elderly Brazilians

Abstract Populational ageing is a current phenomenon and calls for the reconfiguration of health services and expansion of access for the elderly. This is a cross-sectional study with 6,624 elderly Brazilians over 60 that set out to evaluate access to healthcare by measuring lack of access and by describing the trajectory until recourse to hospitalization, emergency care and medical visits. The variables were analyzed according to the nature of funding to access the service (SUS, private insurance and cash-payment). The prevalence of lack of access was 2.5% (CI95% 1.6;4.0) for hospitalizations, 2.1% (CI95% 1.4; 3.1) for emergency rooms, and 0.6% (CI95% 0.3;0.9) for medical visits. SUS accounted for most of the care provided. Positive aspects of SUS were the higher number of medical visits in the city of residence and less money spent on transport. The private system stands out for the low frequency of long waiting times and higher frequency of referrals to return visits after hospitalization. The findings highlight the importance of SUS in Brazil in promoting equality and universality despite the existing deficiencies. In both public and private systems, greater articulation among the healthcare levels is required for integral healthcare to elderly individuals.

摘要：人口老龄化是当前的社会现象，亟需重构医疗服务体系并扩大老年群体的医疗可及性。本研究为横断面研究，纳入6624名60岁以上巴西老年人，旨在通过测量医疗可及性缺口、描述患者直至住院、急诊及门诊就诊的就医轨迹，评估老年群体的医疗可及性情况。本研究依据医疗服务的筹资性质（巴西统一卫生系统SUS、商业保险及自费）对变量进行分析。住院服务的可及性缺口患病率为2.5%（95%置信区间：1.6~4.0），急诊服务为2.1%（95%置信区间：1.4~3.1），门诊就诊为0.6%（95%置信区间：0.3~0.9）。SUS承担了绝大多数的医疗服务供给。SUS的优势在于，参保者在居住地城市的门诊就诊次数更多，且交通花费更低。私立医疗体系则以等待时长过长的发生率更低、住院后复诊转诊率更高为显著优势。研究结果凸显了巴西统一卫生系统（SUS）尽管存在不足，但其在促进医疗公平与普惠性方面的重要价值。无论公立还是私立医疗体系，均需加强不同层级医疗服务间的衔接，以实现老年群体的整合式医疗照护。