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Dual Use of Public and Private Health Care Services in Brazil

Author

Listed:
  • Bianca Silva

    (Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium)

  • Niel Hens

    (Data Science Institute (DSI), I-BioStat, Hasselt University, BE-3500 Hasselt, Belgium)

  • Gustavo Gusso

    (Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil)

  • Susan Lagaert

    (Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium)

  • James Macinko

    (Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health，University of California Los Angeles, Los Angeles, CA 90095, USA)

  • Sara Willems

    (Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium)

Abstract

(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 ( n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users ( n = 6484; 14.7%). Dual use happened both in the direction of public to private ( n = 4628; 67.3%), and of private to public ( n = 1855; 32.7%). Higher income had a significant effect on dual use ( p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region ( p < 0.0001) and usual source of care (USC) ( p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.

Suggested Citation

  • Bianca Silva & Niel Hens & Gustavo Gusso & Susan Lagaert & James Macinko & Sara Willems, 2022. "Dual Use of Public and Private Health Care Services in Brazil," IJERPH, MDPI, vol. 19(3), pages 1-25, February.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1829-:d:743037
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    References listed on IDEAS

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    1. Sanjay Basu & Jason Andrews & Sandeep Kishore & Rajesh Panjabi & David Stuckler, 2012. "Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 9(6), pages 1-14, June.
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    Cited by:

    1. Macinko, James & Seixas, Brayan V. & de Oliveira, Cesar & Lima-Costa, Maria Fernanda, 2022. "Private health insurance, healthcare spending and utilization among older adults: Results from the Brazilian Longitudinal Study of Aging," The Journal of the Economics of Ageing, Elsevier, vol. 23(C).
    2. Stefan Sliwa Ruiz & Malte Becker & Thomas Hone & Rudi Rocha, 2023. "Doctor Turnover and Health Outcomes: Evidence from the Exit of Cuban Doctors in Brazil," Working Papers 18, Instituto de Estudos para Políticas de Saúde.
    3. Lucas Akio Iza Trindade & Jaqueline Lopes Pereira & Jean Michel Rocha Sampaio Leite & Marcelo Macedo Rogero & Regina Mara Fisberg & Flavia Mori Sarti, 2024. "Lifestyle and Cardiometabolic Risk Factors Associated with Impoverishment Due to Out-of-Pocket Health Expenditure in São Paulo City, Brazil," IJERPH, MDPI, vol. 21(9), pages 1-18, September.

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