CHANGES IN THE PREVALENCE OF HEALTH INSURANCE COVERAGE AMONG ADULTS IN BRAZIL: A COMPARATIVE ANALYSIS OF THE NATIONAL HEALTH SURVEY (2013 AND 2019)

Abstract

To estimate the prevalence of medical health plan coverage in the adult population (18 to 59 years), analyzing its variations according to socioeconomic and demographic characteristics between the years 2013 and 2019. A cross-sectional study with secondary data from the 2013 and 2019 National Health Survey (PNS). A total of 121,765 adults in 2013 and 164,291 in 2019 were included. The prevalence of medical health plan coverage was self-reported and described according to socioeconomic and demographic variables. Prevalence rates and respective 95% confidence intervals (95% CI) were estimated for each year. The change in prevalence was presented through the absolute difference, which estimated the magnitude and variation in the period using Generalized Linear Models (GLM) with Gaussian distribution. Pearson’s chi-square test was used to confirm differences. The prevalence of medical health plan coverage decreased to 26.3% (95% CI: 25.5–27.1) in 2019, compared to 29.5% (95% CI: 28.5–30.5) in 2013, with an absolute difference of –3.2% (95% CI: –4.4; –1.8; p-value <0.001). A statistically significant reduction was observed in both sexes, in all ages, racial groups, whether or not inserted in the labor market, education levels, and type of city of residence. However, no change was found for individuals in the highest income level and in the Southern region of the country. A reduction in the prevalence of medical health plan coverage was observed over the six years of the surveys and its association with socioeconomic and demographic characteristics. These findings point to the challenges of the Unified Health System (SUS).