Living conditions and access to health services by Bolivian immigrants in the city of São Paulo, Brazil
METHODS: cross-sectional design based on a sample of adults in two segments: Brazilian nationals with fixed domiciles in census tract with social vulnerability and Bolivian immigrants. A probabilistic sample of 250 immigrants was obtained from a registry. Ten spoke Spanish interviewers were trained for the survey. Difficulties in access reduced the planned sample to 183 Bolivian adults and 417 Brazilian naturals.
RESULTS: the survey obtained information on 94 immigrants living in Brazil for more than 5 years and 81 for less than 5 years. The group consist mainly of young people and adults of both sexes, without partners, with a monthly income of 1 to 3 times the minimum wage, secondary schooling, using Spanish or indigenous language on a daily basis. The established group (>5 years) is older, has a higher proportion with: income > 3 mw, speak Portuguese, and legal resident document. Paid work and employment status are worst for the immigrants. The proportion of immigrants with health insurance is negligible and smaller than that of social vulnerable Brazilians. As compared to Brazilian nationals, Bolivian report more use of primary care services (66%) and less use of outpatient clinics (17%). More Bolivian immigrants rate their health as poor compared to social vulnerable Brazilians nationals (72,8% x 38,8%) and both groups make extensive use of health services in the 30 days prior to the interview. (41,2% x 37,2%) The place of care is significantly different for the groups.
CONCLUSIONS: Living conditions and health status are worst for the Bolivian immigrants but access to health services shows increasing inclusion mostly in primary care.