[Inequalities in access to health care services and utilization for the elderly in São Paulo, Brazil].
OBJECTIVE
To describe factors associated to inequalities in access to health care services and utilization for the elderly.


METHODS
Study part of the Health, Well-being and Aging in Latin America and the Caribbean ("SABE") Survey that included 2,143 elderly individuals aged 60 or older in the city of São Paulo, southeastern Brazil, in 2000. A two-step sampling procedure with probability proportional to size was carried out using census tracts with replacement. To achieve the desired number of respondents aged 75 or older, additional households close to the selected census tracts were sampled. Access to health services and utilization were measured for outpatient and hospital services during a 4-month period prior to the interview, and correlated to factors related to ability, need and predisposition (total income, schooling, health insurance, reported medical condition, self-perception, gender and age).Multivariate logistic regression was performed in the analysis.


RESULTS
Of all respondents, 4.7% reported being hospitalized and 64.4% seeking outpatient care in the four months prior to the study. As for public outpatient care provided, 24.7% were in hospital clinics and 24.1% in other public outpatient services. As for private care, 14.5% received care in hospitals and 33.7% in health clinics. The multivariate analysis showed an association between health service utilization and sex, medical condition, self-perceived health, income, schooling, and health insurance. However, an inverse effect was found for the variable "schooling".


CONCLUSIONS
The study results show inequalities in access to health services and utilization as well as a deficient health care system. Public policies should take into account the specific needs of the elderly population to facilitate access to health care services and reduce inequalities.
Louvison
Marília Cristina Prado
MC
Programa de Pós-graduação em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil. mariliacpl@usp.br
Lebrão
Maria Lúcia
ML
Duarte
Yeda Aparecida Oliveira
YA
Santos
Jair Lício Ferreira
JL
Malik
Ana Maria
AM
Almeida
Eurivaldo Sampaio de
ES
D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D004812:Epidemiologic Methods; D005260:Female; D015577:Geriatric Assessment; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D017061:Prepaid Health Plans; D012017:Referral and Consultation; D012737:Sex Factors; D012943:Social Security; D012959:Socioeconomic Factors