[EQ] Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil

Out-of-pocket health expenditure in a population covered by the Family Health Program in Brazil

Aluísio JD Barros^1,* and Andréa D Bertoldi^1,2

¹Centro de Pesquisas Epidemiológicas, Universidade Federal de Pelotas. Pelotas, RS, Brasil.
²Programa de Pós-graduação em Saúde Coletiva, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil.

International Journal of Epidemiology, doi:10.1093/ije/dyn063 – March 2008

Abstract:
http://ije.oxfordjournals.org/cgi/content/abstract/dyn063v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Andrea+D+Bertoldi&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=//&resourcetype=HWCIT

Background The Brazilian public health system, free and universal, should limit out-of-pocket health expenses. However, Brazil was reported as one of the countries with the highest proportion of families experiencing catastrophic expenditure. This study was designed to assess occurrence of high health spending in a low-income population, as well as the pattern of out-of-pocket health payments.

Methods A cross-sectional study was done in Porto Alegre, Brazil, in 2003, with a sample representative of families covered by the Family Health Program. Health expenses were recorded with reference to 30 days prior to the interview and income data were collected with reference to the previous calendar month. Health expenditure was explored in terms of total household health expenditure >5, 10 and 20% of household income and >40% households capacity to pay.

Results The final study sample included 869 households. Medicines were responsible for 47% of household expenditure with health; second came private health plans which accounted for 22%. The richest spent, on average, 70 times more them the poorest with health plans, 26 times more with dental treatment and six times more with medicines. About 16% households committed 20% or more of their income with health, independent of economic position. Similarly, 12% of the households had health expenditure in excess of 40% of their capacity to pay.

Conclusion The proportion of income spent on health was similar across economic groups, but this ‘equality’ is achieved at an unacceptably high level. Specific strategies to reduce such vulnerability are needed.

Can mothers rely on the Brazilian health system for their deliveries?
An assessment of use of the public system and out-of-pocket expenditure in the 2004 Pelotas Birth Cohort Study, Brazil

Aluísio JD Barros, Iná S Santos and Andréa D Bertoldi
BMC Health Services Research 2008, 8:57 doi:10.1186/1472-6963-8-57

            Available online at: http://www.biomedcentral.com/1472-6963/8/57
           

Background: In a country where comprehensive free health care is provided via a public health system (SUS), an unexpected high frequency of catastrophic out-of-pocket expenditure has been described. We studied how deliveries were financed among mothers of a birth cohort and whether they were an important source of household out-of-pocket expenditure.

Methods: All deliveries occurring in the city of Pelotas, Brazil, during 2004, were recruited for a birth cohort study. All mothers were interviewed just after birth and three months later. Comprehensive data on the pregnancy, delivery, birth conditions and newborn health were collected, along with detailed information on expenses related to the delivery.

Results: The majority of the deliveries (81%) were financed by the public health system, a proportion that increased to more than 95% among the 40% poorest mothers. Less than 1% of these mothers reported some out-of-pocket expenditure. Even among those mothers covered by a private health plan, nearly 50% of births were financed by the SUS. Among the 20% richest, a third of the deliveries were paid by the SUS, 50% by private health plans and 17% by direct payment.

Conclusion: The public health system offered services in quantity and quality enough to attract even beneficiaries of private health plans and spared mothers from the poorest strata of the population of practically any expense.

 

 

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