Inequities in Healthcare utilization: results of the Brazilian National Health Survey, 2013.

BACKGROUND: The Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil.

METHODS: We employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %).

RESULTS: 0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class "E" (AOR = 6.31, 95 % CI = 3.76-10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78-5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30-3.74), males (AOR = 2.16, 95 % CI = 1.99-2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83-2.44). Individuals self-classified as "white" were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75-0.90).

CONCLUSIONS: Despite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.