Dual Use of Public and Private Health Care Services in Brazil

Bianca Silva, Niel Hens, Gustavo Gusso, Susan Lagaert, James Macinko and Sara Willems
Additional contact information
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

IJERPH, 2022, vol. 19, issue 3, 1-25

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.

Keywords: healthcare use; Brazil; public health; private healthcare (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (3)

Downloads: (external link)
https://www.mdpi.com/1660-4601/19/3/1829/pdf (application/pdf)
https://www.mdpi.com/1660-4601/19/3/1829/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:3:p:1829-:d:743037

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().