title: [Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil].
abstract: OBJECTIVE
  To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil.
  
  
  METHODS
  A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n=2163) and two in Brazil (n=2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country.
  
  
  RESULTS
  The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care.
  
  
  CONCLUSIONS
  In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.
authors.affiliation: Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España; Programa de doctorado en Biomedicina, Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España. Electronic address: igarcia@consorci.org.
authors.forename: Irene
authors.initials: I
authors.lastname: Garcia-Subirats
authors.affiliation: Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas Lorenzo
authors.affiliation: Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
authors.forename: Amparo Susana
authors.initials: AS
authors.lastname: Mogollón-Pérez
authors.affiliation: The Prince Leopold Institute of Tropical Medicine, Antwerpen, Bélgica.
authors.forename: Pierre
authors.initials: P
authors.lastname: De Paepe
authors.affiliation: Faculdade de Enfermagem, Universidade de Pernambuco, Recife, Brazil; FIOCRUZ/PE, Recife, Brazil.
authors.forename: Maria Rejane Ferreira
authors.initials: MR
authors.lastname: da Silva
authors.affiliation: The Prince Leopold Institute of Tropical Medicine, Antwerpen, Bélgica.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Unger
authors.affiliation: Grupo de Investigación en Políticas de Salud y Servicios Sanitarios, Servicio de Estudios y Prospectivas en Políticas de Salud, Consorcio de Salud y Social de Cataluña, Barcelona, España.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Vázquez Navarrete
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001938:Brazil; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003105:Colombia; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D019458:Insurance Coverage; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data; D012494:Sampling Studies; D012943:Social Security / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Atención de urgencias; Atención especializada; Atención primaria de salud; Brasil; Brazil; Colombia; Emergency care; Factores socioeconómicos; Health Services/utilization; Primary health care; Secondary care; Servicios de salud/utilización; Socioeconomic factors