title: Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008.
abstract: OBJECTIVE
  To analyze the evolution and determinants of income-related inequalities in the Brazilian health system between 1998 and 2008.
  
  
  METHODS
  Data from the National Household Sampling Surveys of 1998, 2003, and 2008 were used to analyze inequalities in health and health care. Health was measured by self-reported health status, physical limitations, and chronic illness. Hospitalization and physician and dentist visits were proxies for health care utilization. Income was a proxy for socioeconomic status. Concentration indices were calculated before and after standardization for all dependent variables. Decomposition analysis was used to identify the main determinants of inequality in health care utilization.
  
  
  RESULTS
  In all three periods analyzed, the poor reported worse health status, while the wealthy reported more chronic diseases; health care utilization was pro-rich for medical and dental services. Yet, income-related inequality in health care utilization has been declining. Private health insurance, education, and income are the major contributors to the inequalities identified.
  
  
  CONCLUSIONS
  Income-related inequality in the use of medical and dental health care is gradually declining in Brazil. The decline is associated with implementation of pro-equity policies and programs, such as the Community Health Agents Program and the Family Health Program.
authors.affiliation: Pan American Health Organization, Washington, D.C., United States of America.
authors.forename: Gisele
authors.initials: G
authors.lastname: Almeida
authors.forename: Flavia Mori
authors.initials: FM
authors.lastname: Sarti
authors.forename: Fernando Fagundes
authors.initials: FF
authors.lastname: Ferreira
authors.forename: Maria Dolores Montoya
authors.initials: MD
authors.lastname: Diaz
authors.forename: Antonio Carlos Coelho
authors.initials: AC
authors.lastname: Campino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult