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Equity of Access to Outpatient Care and Hospitalization Among Older Community Residents in Brazil

Blay, Sergio L. MD, PhD*; Fillenbaum, Gerda G. PhD; Andreoli, Sergio Baxter MD, PhD*; Gastal, Fábio Leite MD, PhD

doi: 10.1097/MLR.0b013e318179254c
Original Article

Objective: To determine whether, as mandated by Brazilian law, health care (outpatient care, hospitalization) among older community residents is based on health-related criteria and not on other characteristics.

Research Design: Cross-sectional, population-representative.

Subjects: Multistage, random sample of 7040 household residents aged ≥60 years in the state of Rio Grande do Sul, Brazil.

Measures: Structured in-person interviews to determine sociodemographic characteristics, self-reported health conditions, psychiatric status, outpatient service use within the previous 6 months, and number of hospitalizations within the previous 12 months.

Results: Seventy two percent reported an outpatient visit, 20% reported hospitalization. In controlled analyses, being female, older, unemployed, having private health insurance, increased the odds of an outpatient visit. Males, older persons, the insured, and more educated were more likely to report hospitalization. Race/ethnicity and religious affiliation were not associated with outpatient or hospital use. Pneumonia, heart disease, and urinary tract infection were particularly associated with both outpatient visits and hospitalization; diabetes, hypertension, and cancer with outpatient visit; stroke, cancer and psychiatric disorder with hospitalization; and heart disease, pneumonia, and psychiatric disorder with multiple hospitalizations.

Conclusions: Use of health services did not differ by race/ethnicity or religion, but private health insurance facilitated outpatient access, and increased education facilitated hospitalization. Gender, age, and employment status likely reflected differential health needs. Improved access is needed for older persons lacking private health insurance, and those with little education. Patients with psychiatric problems merit increased attention to reduce excessive hospitalization.

From the *Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil; †Center for the Study of Aging and Human Development, Duke University Medical Center, and Geriatric Research, Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina; and ‡Project Scientific Committee, Brazil.

Supported by grants from Conselho Estadual do Idoso, Secretaria do Trabalho, Cidadania e Assistência Social, and by Governo do Estado do Rio Grande do Sul. Dr. Fillenbaum was partially supported by National Institute on Aging grant number 1P30 AG028716-01 Claude D. Pepper OAIC.

Reprints: Dr. Sergio Luís Blay, MD, PhD, Department of Psychiatry, UNIFESP R. Botucatu, 740 CEP 04023-900 São Paulo, São Paulo, Brazil. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.