Health care provider choice and utilization among the elderly in a state in Brazil: a structural model.
OBJECTIVE
Current demographic trends point to the need for understanding the health challenges facing the elderly in Latin America today. This study assessed whether health care provider choice and household income impact utilization and health among the elderly in Brazil.


METHODS
Using a sample taken in 1995 in southern Brazil, a structural model was used to estimate the parameters of a function that represents the choice of health care provider, controlled for health care services utilization and a health production function. The dependent variable for the production function was self-assessed health. These two functions were structurally linked by introducing the probability of choosing a private over a public provider in the health production function as an added explanatory variable. With this structural linkage, the production function assessed how much the selection of a public versus a private provider affects health, while controlling for the possibility that individuals with poorer health have a tendency to prefer one or other health care provider.


RESULTS
Health care services utilization by the elderly was constrained by two factors: the number of providers at the municipality level and household income. The elderly who live in municipalities with a greater number of public, outpatient clinics and providers were more likely to use the public system. Patients who used the public health care system had lower self-assessed health status than those using the private system. This result is valid even after controlling for demographic variables and morbidity.


CONCLUSIONS
Brazil's public health system does not adequately provide for the health needs of the elderly population. Policy recommendations include further investments in the public health care infrastructure, full implementation of the National Plan for Elderly Health, and developing new programs for effective geriatric consultations at the primary care level.
Bos
Antonio M
AM
Tusculum College, Greeneville, Tennessee 37743, USA. abos@tusculum.edu
D000368:Aged / Q000523:psychology*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001938:Brazil; D002755:Choice Behavior; D003151:Community Health Centers / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006269:Health Facilities, Proprietary / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data; D006291:Health Policy; D006304:Health Status; D006801:Humans; D007182:Income; D008962:Models, Theoretical; D009313:National Health Programs / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011157:Population Dynamics; D011787:Quality of Health Care; D012647:Self-Assessment