title: Utilization of medical services in the public health system in the Southern Brazil.
abstract: OBJECTIVE
  To estimate the prevalence and analyze factors associated with the utilization of medical services in the public health system.
  
  
  METHODS
  Cross-sectional population-based study with 2,706 individuals aged 20-69 years carried out in Pelotas, Southern Brazil, in 2008. A systematic sampling with probability proportional to the number of households in each sector was adopted. The outcome was defined by the combination of the questions related to medical consultation in the previous three months and place. The exposure variables were: sex, age, marital status, level of schooling, family income, self-reported hospital admission in the previous year, having a regular physician, self-perception of health, and the main reason for the last consultation. Descriptive analysis was stratified by sex and the analytical statistics included the use of the Wald test for tendency and heterogeneity in the crude analysis and Poisson regression with robust variance in the adjusted analysis, taking into consideration cluster sampling.
  
  
  RESULTS
  The prevalence of utilization of medical services in the three previous months was 60.6%, almost half of these (42.0%, 95%CI: 36.6;47.5) in public services. The most utilized public services were the primary care units (49.5%). In the adjusted analysis stratified by sex, men with advanced age and young women had higher probability of using the medical services in the public system. In both sexes, low level of schooling, low per capita family income, not having a regular physician and hospital admission in the previous year were associated with the outcome.
  
  
  CONCLUSIONS
  Despite the expressive reduction in the utilization of medical health services in the public system in the last 15 years, the public services are now reaching a previously unassisted portion of the population (individuals with low income and schooling).
authors.affiliation: Departamento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil. gnader@terra.com.br
authors.forename: Gisele Alsina Nader
authors.initials: GA
authors.lastname: Bastos
authors.forename: Giovâni Firpo Del
authors.initials: GF
authors.lastname: Duca
authors.forename: Pedro Curi
authors.initials: PC
authors.lastname: Hallal
authors.forename: Iná S
authors.initials: IS
authors.lastname: Santos
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011634:Public Health / Q000706:statistics & numerical data*; D012494:Sampling Studies; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult