Health socioeconomic inequalities in Brazil: results of the World Health Survey, 2003

OBJETIVO: como parte do projeto da Organiza????o Mundial da Sa??de de avalia????o de desempenho dos sistemas de sa??de das na????es, a Pesquisa Mundial de Sa??de (PMS) foi realizada no Brasil, em 2003. O presente trabalho tem o objetivo de apresentar algumas evid??ncias de desigualdades socioecon??micas em sa??de por meio das informa????es coletadas na PMS brasileira. M??TODOS: o inqu??rito populacional foi realizado em 5000 domic??lios, selecionados por amostragem probabil??stica. Para examinar as desigualdades socioecon??micas, tr??s vari??veis foram consideradas: grau de escolaridade; n??mero de bens do domic??lio; e situa????o de trabalho. Mediante modelos de regress??o log??stica, foram identificados os determinantes da auto-avalia????o de sa??de boa e das coberturas de exame ginecol??gico e mamografia. Quanto ao desempenho do sistema de sa??de, o atendimento foi avaliado de acordo com as expectativas do usu??rio. RESULTADOS: constatou-se acentuado gradiente social no estado de sa??de bem como na cobertura dos exames preventivos de sa??de entre as mulheres. Comparando-se a avalia????o do atendimento por forma de pagamento, o percentual de avalia????o "boa" foi sempre menor para os usu??rios do SUS, para qualquer um dos aspectos avaliados. CONCLUS??ES: as desigualdades em sa??de aqui evidenciadas devem ser consideradas para subsidiar as pol??ticas p??blicas e a????es do sistema de sa??de que atendam as reais necessidades da popula????o, voltadas ?? supera????o da exclus??o social.Objective: as part of the World Health Organization project of nations' the World Health Survey was performed in Brazil in 2003. This paper has the objective of disclosing social and economic health inequalities through information collected in the Brazilian World Health Survey. Methods: the population-based survey was conducted in 5000 households selected by probabilistic sampling. To assess social and economic inequalities, three variables were considered: schooling level, number of household belongings and employment status. Logistic regression models were used to establish socioeconomic determinant factors of good self-rated health, as well as periodic gynecologic examination and mammography. As for the health system performance, services were evaluated according to users' expectations. Results: an outstanding social grading was determined for self-rated health as well as for the coverage of preventive periodic health exams among women. When comparing evaluation of healthcare through payment, "good" rating percentage was always lower for SUS (universal healthcare public system) users for all of the aspects assessed. Conclusions: healthcare inequalities as demonstrated here should be considered to subsidize public policies and actions of the healthcare system that meet real population needs to overcome social exclusion