RIO DE JANEIRO, BRAZIL – One in four Brazilians failed to receive health care on their first attempt. This is shown in the new IBGE (Brazilian Institute of Geography and Statistics) National Health Survey (PNS), released on Friday morning, September 4th.
According to the survey, of the 39 million people who sought health care in the two weeks prior to the interview date, 26.4 percent failed to access care on the first try either in the public or private network. In 2013, 95.3 percent were assisted on their first attempt.
Among those who received health care, 60.9 percent had some prescription medication, and 85 percent obtained all the prescribed medications. When the reference for obtaining medication is the public service, the proportion of people who secured at least one prescription medication is lower, at 30.5 percent.
In Brazil, the most frequently mentioned reasons for seeking health care were illness or treatment of illness (48.2 percent) and routine care, such as vaccination, prevention, medical check-up, or follow-up with another health professional (25.1 percent). This pattern was quite similar in all regions. However, the ideal pattern would be for most visits to a health facility to be for prevention; rather than for treatment, experts say.
Furthermore, the survey shows that Brazilians are “strongly dependent” on the public health service. According to the survey, the vast majority of the population (71.5 percent) relies on the National Health System (SUS). Only 28 percent have a complementary health plan, a percentage that has remained stable since the last edition of the PNS in 2013.
Approximately half of Brazilians (46.8 percent) referred to the public Basic Health Unit as the facility they most frequently seek when they need medical care. The Emergency Care Units (UPAs), emergency rooms, or public hospital emergencies were preferred by 14.1 percent, and specialty centers, public polyclinics, or public hospital outpatient clinics were chosen by 8.9 percent.
Painter Cícero Ferreira, 55, is one of the millions of users of the public health system and complains about the delay in care. He, his wife, and stepdaughter, who live in Barra de Jangada, in the metropolitan region of Recife, Pernambuco, never had a health plan. When they need medical care, they look for the nearest Emergency Care Unit (UPA).
“When I need to, I go to the neighborhood UPA or the one close to work, in Imbiribeira. In both, it is always an endless bureaucracy. It can be a mild illness or something serious. When anyone at home needs to go, we get there in the morning and spend the whole day there, we only leave the place at night. We go through several stages and it’s a very long wait. A day goes by before we get medical attention,” he said.
Private doctors’ offices and private clinics were referred by 22.9 percent of respondents. The ready care and emergencies sections of private hospitals are preferred by 4.4 percent of Brazilians.
The PNS 2019 showed that 159.6 million (76.2 percent) people in Brazil had seen a doctor in the 12 months prior to the interview – an increase over 2013 (71.2 percent), regardless of gender, age group, color or race, or schooling.
According to the survey, 60.0 percent (44.0 million) of households were registered in Family Health Units, an increase of 6.7 percentage points over 2013, when 53.3 percent (34.6 million) were registered.
Katia Silva, 43, is a housemaid and also claims to struggle to be attended by SUS. With no health plan, she says she has already waited months to secure an appointment and has even gone to a private popular clinic.
“I’ve had to reach the health center before six in the morning and face a line to secure a number. After a long wait, I was seen, but I was not referred to a gynecologist to show my exams. I had to go through the whole procedure again to try to schedule an appointment, but it took months and I was unable to. So I ended up paying for an appointment at a popular clinic, around R$100, to be seen. Since then, this is what I do every time I need to,” she said.
According to Katia, bureaucracy is the main problem in public health care. “I have already spent nearly a whole day waiting in line to be helped. When it was my turn, they said I wouldn’t be seen because the system said I was a return appointment, but it was my first appointment. I took a referral and have been waiting since 2019 for a call from the health center for an appointment with an orthopedist.”
However, among the households registered a year or more ago, it was noted that approximately 23.8 percent (9.5 million) had never been visited by a community health worker or a member of the Family Health team, which reflects a strong increase compared to 2013 when this percentage stood at 17.7 percent (5.3 million).
Health Plans
Just under a third of the population, 28.5 percent, declared having some kind of health, medical, or dental plan – a percentage similar to that recorded six years ago, 27.9 percent. In terms of private care, the country’s inequalities are more striking.
The Southeast and South regions had the highest coverage proportional to their populations (34.9 and 30.5 percent, respectively). Among the states, São Paulo and the Federal District stood out, well above the national average, with the highest proportions of people in this condition (38.4 and 37.4 percent, respectively). Maranhão (5.0 percent) and Roraima (7.4 percent) stood out as the states with the lowest indicators of medical health plan coverage.
In relation to schooling, it was observed that the higher the education level, the higher the percentage of health plan coverage, varying from 16.1 percent among people with no schooling or with incomplete elementary schooling to 67.6 percent among those with complete higher education.
In terms of income, the gap widens even further: only 2.2 percent of people with no income or earning up to 1/4 of the minimum wage had some medical health plan; on the other hand, 86.8 percent of those earning over five minimum monthly salaries (roughly US$1,000) were covered by some supplementary health service.
Dental health
The survey also showed that less than half of Brazilians (49.4 percent) had seen a dentist in the 12 months preceding the interview date. “One can say that the attention with oral health is still poor in the country,” assessed the survey.
The North and Northeast Regions registered the lowest proportions of people who had seen a dentist (40.8 and 43.3 percent, respectively), while the South and Southeast Regions had the highest proportions (55.8 and 53.0 percent).
Nevertheless, as noted in relation to doctor visits, the proportion of people who saw a dentist rose considerably between 2013 and 2019 (from 44.4 to 49.4 percent).
The results also show that in 2019, dental health plan coverage was much less common than that of the medical type: 12.9 percent against 26.0 percent, even in the higher income brackets.
Home conditions
The National Health Research has also assessed the sanitary conditions of homes, which have a direct influence on the population’s health. In 96.7 percent of households running water was found in at least one room, an increase over 2013 (93.7 percent). In Brazil, 91.4 percent of homes have garbage collection by a public service, directly or in dumpsters.
But the situation is still well below the ideal when counting bathrooms and sanitary draining by a general sewage system or a septic tank connected to the general network: 66 percent. The regional differences are considerable. While in the Southeast the proportion stands at 88.7 percent, in the North it is only 20.8 percent.
And the situation in fighting endemic diseases has also worsened. According to the study, 64,6 percent of households received the visit of at least one health agent in the 12 months prior to the interview. In 2013, this percentage stood at 69.3 percent.
Source: Estadão Conteúdo