Factors associated with poor access to health services in Brazil

Abstract

Objective: To analyze factors associated with poor access to health services among the Brazilian population aged 19 years or older. Methods: This is a cross-sectional study based on data from the 2013 National Health Survey, obtained from a complex sample. The poor access outcome was defined as not having received care the last time the participant sought a health service and not seeking care again for lack of accessibility. We analyzed the prevalence of poor access and its association with socioeconomic and health factors by calculating prevalence ratios (PR) with 95% confidence intervals. We also used Poisson’s multivariate regression model with the Wald test for robust estimation. Results: Out of the 60,202 valid responses, 12,435 individuals met the criteria for poor access. Poor access had a prevalence of 18.1% (95%CI 16.8 – 19.4) and was associated with the following factors: being black/multiracial (PR = 1.2; 95%CI 1.0 – 1.4); living in the North (PR = 1.5; 1.3 – 1.9) and Northeast (PR = 1.4; 1.2 – 1.6) regions compared to the Southeast region; living in a rural area (PR = 1.2; 1.1 – 1.4); being a smoker (PR = 1.2; 1.0 – 1.4); having poor/very poor self-rated health (PR = 1.3; 1.1 – 1.6); not having private health insurance (PR = 2.3; 1.7 – 2.9). Conclusion: Access to health services is still precarious for a considerable part of the Brazilian population, especially the most vulnerable groups.