TY - JOUR
T1 - Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil
AU - Garcia-Subirats, Irene
AU - Vargas Lorenzo, Ingrid
AU - Mogollón-Pérez, Amparo Susana
AU - De Paepe, Pierre
AU - da Silva, Maria Rejane Ferreira
AU - Unger, Jean Pierre
AU - Vázquez Navarrete, María Luisa
N1 - Funding Information:
Los autores agradecen el tiempo y la disponibilidad de las personas que participaron en el estudio. Este art?culo forma parte de la tesis doctoral que Irene Garcia-Subirats realiza en la Universidad Pompeu Fabra de Barcelona.
Publisher Copyright:
© 2014
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Objective: To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. Methods: A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n = 2163) and two in Brazil (n = 2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. Results: The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. Conclusions: In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.
AB - Objective: To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. Methods: A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n = 2163) and two in Brazil (n = 2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. Results: The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. Conclusions: In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care.
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U2 - 10.1016/j.gaceta.2014.05.010
DO - 10.1016/j.gaceta.2014.05.010
M3 - Artículo
C2 - 25048392
AN - SCOPUS:84924063337
SN - 0213-9111
VL - 28
SP - 480
EP - 488
JO - Gaceta Sanitaria
JF - Gaceta Sanitaria
IS - 6
ER -