Ensaios em Desigualdades Socioeconômicas em Saúde

Abstract

This thesis addresses two essays in the field of health economics within the Brazilian context, using data from the National Health Survey (PNS) for the years 2013 and 2019. The first essay investigated health achievement using the calculation of the Achievement Index. For this purpose, two health outcomes were analyzed: self-rated health as poor and the diagnosis of chronic diseases, considering the 26 states and the Federal District of Brazil. The main findings revealed that poor self-rated health is more concentrated among low-income individuals in all states. In contrast, the diagnosis of chronic diseases showed a higher concentration among high-income individuals in most states. The analysis by federal units highlighted significant regional disparities in self-rated health, revealing inequalities across Brazilian regions. Overall, the South region demonstrated better achievements in self-rated health, whereas the North region, with the exception of two states, showed worse outcomes. Regarding health achievement related to the diagnosis of chronic diseases, the results indicate lower achievement in most states. The second essay focused on socioeconomic inequality in self-rated health as good or very good across nine age groups. The Concentration Index was employed as the method of analysis, allowing for the evaluation of inequality magnitudes. The results showed that the prevalence of good or very good self-rated health decreases with age. Among the lower income quintiles, individuals aged 70 years or older had higher prevalence rates in both periods analyzed. The Concentration Index revealed that self-rated health as good or very good was predominantly concentrated among high-income individuals across all age groups. The stratification by age showed that the highest concentration occurred in the 50–59 age group in 2013 and in the 60–69 age group in 2019. The analysis also identified the key factors contributing to health inequality, ranked in order of importance: socioeconomic status, educational attainment, possession of a health insurance plan, and residence in the Southeast region. While this study offers valuable contributions to the analysis of health inequalities in Brazil, it is essential to acknowledge its limitations. The data used are cross-sectional, which prevents the monitoring of the same population over time. Furthermore, the analyzed variables were based on self-reported data, which may introduce biases such as underreporting or overreporting of health conditions due to individual perceptions or cultural differences across regions. These aspects should be taken into account when interpreting the results and formulating public policies based on this research. These essays emphasize the importance of analyzing health inequalities through a multifactorial lens, considering socioeconomic and demographic conditions. The thesis aimed to contribute to the literature by offering a comprehensive view of regional and age related disparities in the health of the Brazilian population, using robust methods to assess socioeconomic inequalities in health.