[Health surveys and use of maternal and child health care services in three municipalities within the São Paulo metropolitan area].
OBJECTIVE
To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboão da Serra-in the São Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes.


METHODS
Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the São Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions.


RESULTS
The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of São Paulo (in 1990, 80% of deliveries and almost all admissions for children less than 1 year versus 32% and 46%, respectively, in 2002). The use of primary care units and 24-hour walk-in clinics also increased. All these changes reflect care provided by public resources. In the private sector, there was a decrease in direct payments and payments through company-paid health insurance and an increase in payments through self-paid health insurance.


CONCLUSIONS
The major changes observed in the second survey occurred simultaneous to the changes that resulted from the implementation of the SUS. Population-based health surveys are adequate for analyzing and comparing the utilization of health care services at different times.
de Carvalho
Wladithe Organ
WO
Universidade Estadual de Londrina, Departamento de Saúde Coletiva; Avenida Robert Koch 60, Vila Operária, CEP 86039-440, Londrina, PR, Brasil. wladithe@terra.com.br
Cesar
Chester Luiz Galvão
CL
Carandina
Luana
L
Barros
Marilisa Berti de Azevedo
MB
Alves
Maria Cecília Goi Porto
MC
Goldbaum
Moisés
M
D000293:Adolescent; D000328:Adult; D001938:Brazil; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008430:Maternal-Child Health Centers / Q000706:statistics & numerical data*; D014505:Urban Population; D055815:Young Adult