Inequalities in health services utilization among brazilian and US elderly

Introduction: This study assesses how socioeconomic position affects access to and use of healthcare services among older adults in Brazil and the United States. Methods: Analysis of nationally-representative health interview surveys, 2007-2009 NHIS (US) and 2008 PNAD (Brazil). Outcome measures include: no doctor visit, number of doctor visits, any hospitalization, number of hospitalizations, usual source of medical care, and barriers to care during the past year. Multiple Poisson and Hurdle regressions model healthcare use and the intensity of use, respectively. Independent variables include: income, schooling, age, gender, presence of a spouse, urban/rural residence, private and public health insurance, and self-reported health problems and limitations. Linear and quadratic interactions among age and schooling model the effects of social inequalities on healthcare access across different ages. Results: Utilization rates for most healthcare services were higher in the US than in Brazil, except among the highest users of services, where rates were similar. Within-county inequalities (comparing highest to lowest levels of schooling) were lowest in both countries for hospitalizations, and highest for having no doctor visits in the past 12 months. For most (but not all) outcomes, education-related inequalities were most pronounced in mid-life, and subsequently diminished with older ages. Conclusion: The two countries' different approaches to providing access to healthcare have implications for treatment and prevention of chronic and other conditions across the life course. However, even among the older (aged 65+) population, where both countries provide universal access, considerable social inequalities in meeting basic healthcare needs persist.