Utilization of health care services in Brazil: gender, family characteristics, and social status

Objetivo. Investigar o perfil de utiliza????o de servi??os de sa??de por homens e mulheres no Brasil. M??todos. Utilizaram-se os dados da Pesquisa Nacional por Amostra de Domic??lios realizada em 1998. Foram desenvolvidos modelos de regress??o log??stica para analisar as informa????es relativas a homens e mulheres com e sem restri????o de atividades por motivos de sa??de nos 15 dias que antecederam a pesquisa. As vari??veis individuais foram: posi????o no mercado de trabalho, escolaridade e ra??a. Tamb??m foram analisadas vari??veis relativas ?? fam??lia: renda familiar per capita, tamanho da fam??lia e escolaridade e posi????o do chefe da fam??lia no mercado de trabalho. Nos modelos em dois n??veis (vari??veis individuais e familiares) evidenciouse um efeito de fam??lia que, entretanto, n??o foi captado pelas vari??veis analisadas. Resultados. As mulheres utilizaram mais os servi??os de sa??de, mesmo quando controlado o efeito da restri????o de atividades por motivo de sa??de. O uso de servi??os de sa??de por homens e mulheres dependeu do poder aquisitivo das fam??lias e das caracter??sticas sociais do pr??prio indiv??duo, definindo um perfil de desigualdades sociais. Observaram-se diferen??as no perfil de desigualdade nos g??neros entre pessoas que referiram e n??o referiram restri????o de atividades. As vari??veis familiares tiveram maior import??ncia na explica????o do consumo de servi??os por pessoas sem restri????o de atividade. Conclus??es. A formula????o de pol??ticas voltadas para a redu????o das desigualdades no consumo de servi??os de sa??de deve considerar as diferen??as entre mulheres e homens, al??m da import??ncia das caracter??sticas familiares. Ressalta-se a necessidade de incluir as dimens??es g??nero e fam??lia na especifica????o dos modelos de uso de servi??os de sa??de.Objective. To investigate the pattern of utilization of health care services by men and by women in Brazil. Methods. We used data from the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domic??lios) carried out in 1998. Logistic regression models were developed to analyze information concerning men and women who had and who did not have restrictions in their routine activities due to health problems during the 15 days before the survey. The individual variables considered were: labor market position (type of employment), amount of schooling completed, and race. Also analyzed were family-related variables: per capita family income, size of the family, and, for the head of the family, the amount of schooling and labor market position. The two-level models (with family and individual variables) showed an effect from family characteristics, but the variables analyzed did not explain that effect. Results. Women used health services more often than did men, even after controlling for restrictions in routine activities due to health reasons. The use of health services by men and women was dependent on family income and on the social status of the individual, indicating a pattern of social inequality. In both the group with restrictions in their activities and in the group without such restrictions, the men and women differed from each other in their utilization of health care services. Family variables were more important in explaining the utilization of health services among people without restrictions in their activities. Conclusions. Policies aimed at reducing inequalities in access to health care services must take into consideration the differences between women and men as well as the importance of family characteristics. It is also important to stress the need to include the dimensions of gender and family in the design of health service utilization models