Analysis of factors associated with utilization and costs of health care in the context of Andersen's model: population-based study in the municipality of Sao Paulo, 2003-2015

Abstract

The decision-making process for planning and management of public policy of health presented increasing challenges in the last decades, due to the complexity generated by the simultaneous occurrence of changes in age structure (demographic transition) and lifestyle (nutritional transition) of the population, which result in modifications in morbidity patterns of individuals (epidemiologic transition) towards higher prevalence of noncommunicable diseases (NCD). The NCD represent substantial social and economic impact for health systems and individuals, considering the direct and indirect costs involved in the treatment, recovery, productivity losses, and reduction in quality of life of patients. The existence of robust evidence in factors associated with the utilization of health services by the local population favors improvements in the process of design of strategic actions directed towards disease prevention and health promotion. The theoretical approach of the Andersen's health services utilization model allows structuring the demand of health assistance based on the analysis of predisposing factors (sociocultural characteristics), enabling factors (logistic and economic characteristics), and need factors (health status) of individuals. However, there is lack of evidence on the factors associated with the demand for health care in Brazil based on the theoretical background of Andersen's model, especially considering studies with data representative at population level with data availability on multiple dimensions of individual's lifestyle (e.g., diet, physical activity, sedentarism, among others), in combination with psychological characteristics and data on biochemical and genetic diagnostic exams to assess individual's health status. Thus, the present project proposes to analyze factors associated with the use and the costs of health care in public and private sector of individuals living in Sao Paulo municipality, particularly among individuals with higher cardiometabolic risk, through the theoretical approach of Andersen's model. The study comprises an observational analysis of cross-sectional data using quantitative analysis of data from the Health Survey of Sao Paulo (ISA-Capital) 2003, 2008 and 2015, representative at population level for Sao Paulo municipality. Private health care costs (out-of-pocket) were declared by individuals interviewed in the three editions of the survey. The costs of utilization of health care within the Brazilian Unified Health System (Sistema Único de Saúde, SUS), financed by the public sector, will be estimated using expenditures registered at DATASUS in Sao Paulo municipality in the period of the surveys, considering type of health care and disease reported. Multivariate linear and logistic regression models will be estimated for health care utilization and costs. The statistical analyses will be performed using the Stata software, considering the survey complex sampling procedures, based on two stage probabilistic sample. The results will be interpreted using the structure of Andersen's model, seeking to propose strategies for proposition and assessment of public policies in health directed towards health promotion in the context of primary health care of the SUS and the supplementary private health system. (AU)