HOSPITALIZATION TRENDS AMONG ADULTS WITH HYPERTENSION AND DIABETES: POPULATION-BASED HEALTH SURVEYS - SÃO PAULO, BRAZIL
METHODS: Data from two cross-sectional population-based Health Surveys (ISA-Capital 2003 and ISA-Capital 2008), carried out by home interviews. Target population were from both sexes, 20 years old and greater, who reported suffering from hypertension and diabetes mellitus . Using a combined dataset and Stata 11, prevalence estimates were performed and prevalence ratios were calculated by Poisson regression considering the complex sample design of the surveys.
RESULTS: In 2003, there was no significant difference in hospitalization proportion according to age and schooling. Although, a statistically significant difference (p=0.016) was found in hospitalization percentages according to sex in population with self-reported hypertension (men: 17.6% versus women: 8.6%). In 2008, there was no significant difference in hospitalization proportions. Also, there was a significant increase in hospitalizations proportion covered by private health plans in the period 2003-2008: for hypertensive and/or diabetics, the percentage in 2008 (26.6%) was 3.06 times the percentage in 2003 (8.7%) (p=0.020). Furthermore, there was an increase in hospitalizations proportion covered by health insurance companies in hypertensive women, from 5.6% in 2003 to 30.1% in 2008 (p=0.008) and in hypertensive/diabetics women, from 4.5% to 33.0% (p<0.001).
CONCLUSIONS: The difference in hospitalization proportion in women may be explained by coverage expansion of private health plans in Brazil. Recently, there has been an increase in companies offering private health plans to employees, which may have contributed to our findings. Brazilian health system has seen an increasing number of private services hiring to comply with health demands. Public service cannot fully attend population health demands, which violates the principle of universality proposed by the Brazilian Unified Health System.