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

Irene Garcia-Subirats; Ingrid Vargas Lorenzo; Amparo Susana Mogollón-Pérez; Pierre De Paepe; Maria Rejane Ferreira da Silva; Jean Pierre Unger; María Luisa Vázquez Navarrete

doi:10.1016/j.gaceta.2014.05.010

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

Translated title of the contribution: Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil

Irene Garcia-Subirats, Ingrid Vargas Lorenzo, Amparo Susana Mogollón-Pérez, Pierre De Paepe, Maria Rejane Ferreira da Silva, Jean Pierre Unger, María Luisa Vázquez Navarrete

Research output: Contribution to journal › A1: Web of Science-article › peer-review

Abstract

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.

Translated title of the contribution	Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil
Original language	Spanish
Journal	Gaceta Sanitaria
Volume	28
Issue number	6
Pages (from-to)	480-488
Number of pages	9
ISSN	0213-9111
DOIs	https://doi.org/10.1016/j.gaceta.2014.05.010
Publication status	Published - 2014

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10.1016/j.gaceta.2014.05.010

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Garcia-Subirats, I., Vargas Lorenzo, I., Mogollón-Pérez, A. S., De Paepe, P., da Silva, M. R. F., Unger, J. P., & Vázquez Navarrete, M. L. (2014). 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. Gaceta Sanitaria, 28(6), 480-488. https://doi.org/10.1016/j.gaceta.2014.05.010

@article{08c201b40c824474a021e4c1be02cfff,

title = "Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema {\'U}nico de Salud en Colombia y Brasil",

abstract = "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.",

author = "Irene Garcia-Subirats and {Vargas Lorenzo}, Ingrid and Mogoll{\'o}n-P{\'e}rez, {Amparo Susana} and {De Paepe}, Pierre and {da Silva}, {Maria Rejane Ferreira} and Unger, {Jean Pierre} and {V{\'a}zquez Navarrete}, {Mar{\'i}a Luisa}",

note = "Copyright {\textcopyright} 2014. Published by Elsevier Espana.",

year = "2014",

doi = "10.1016/j.gaceta.2014.05.010",

language = "Spanish",

volume = "28",

pages = "480--488",

journal = "Gaceta Sanitaria",

issn = "0213-9111",

publisher = "Ediciones Doyma, S.L.",

number = "6",

}

Garcia-Subirats, I, Vargas Lorenzo, I, Mogollón-Pérez, AS, De Paepe, P, da Silva, MRF, Unger, JP & Vázquez Navarrete, ML 2014, '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', Gaceta Sanitaria, vol. 28, no. 6, pp. 480-488. https://doi.org/10.1016/j.gaceta.2014.05.010

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. / Garcia-Subirats, Irene; Vargas Lorenzo, Ingrid; Mogollón-Pérez, Amparo Susana et al.
In: Gaceta Sanitaria, Vol. 28, No. 6, 2014, p. 480-488.

Research output: Contribution to journal › A1: Web of Science-article › peer-review

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

PY - 2014

Y1 - 2014

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.

U2 - 10.1016/j.gaceta.2014.05.010

DO - 10.1016/j.gaceta.2014.05.010

M3 - A1: Web of Science-article

C2 - 25048392

SN - 0213-9111

VL - 28

SP - 480

EP - 488

JO - Gaceta Sanitaria

JF - Gaceta Sanitaria

IS - 6

ER -

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

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