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the poorest and richest income quintiles. As can be seen, the gap in health services utilization between the poorest and the richest quintile is close to 30 percent in all ages for men and women.
Health Services Utilization in Brazil: Gaps between Public and Private Coverage Despite having a universal single health system (SUS) with free health care access for all citizens, the Brazilian population has some complaints about the quality of and access to health care. Health indicators show that, besides the fast and huge improvements brought about by SUS, some inequality in access to health care and differential health outcomes between the poor and the rich still exist. The upper and middle classes in Brazil do not use SUS as often as lower-income groups. Besides SUS, a large voluntary private health insurance scheme provides health care to 25 percent of the Brazilian population, with a higher satisfaction among users. A study based on the 1998 Brazilian household survey (Ribeiro 2005) found that: (a) the population insured by private voluntary health plans was more satisfied with their health status than the population who depended on SUS; and (b) for both groups (with and without private voluntary health plan coverage), health status worsened as the population aged, and the incidence of chronic conditions increased. Many determinants, such as higher income or educational level, could explain why the population covered by private health plans is more optimistic about their health status than the population covered by SUS. However, men covered by private health plans use ambulatory facilities 50 percent more often than men covered by SUS, and women covered by private health plans use ambulatory facilities 30 percent more often than women covered by SUS. In addition, the number of medical visits for private health plan users is 13 percent higher for men than in SUS and 17 percent higher for women. On one hand, private health plan beneficiaries have fewer hospitalizations than SUS users. So, a positive perception of one’s own health status could be associated with higher coverage in medical visits, and eventually promotion and prevention provided by the private health plans.14 On the other hand, a negative perception of health status is commonly associated with the higher use of acute health care facilities, such as hospital emergency rooms. Figure 4.20 shows that the number of medical visits for the population affiliated with private health plans is substantially higher than the number for SUS users. Otherwise, despite the huge differentials in the