Use and financing of health services: ten years of information of the National Household Survey
Since the 1950s, researchers in the area of health systems and services have acknowledged the importance of perceiving the area as a topic worthy of investigation. The history of the development of health surveys of the population has close ties with the emergence of the thematic area of Research into Health Services. This area is geared to the study of the various components of the organization of health systems and healthcare processes, with a view to contribute positively to the impact of the latter on the health of the population. It therefore involves the health needs of population groups, the characteristics of supply and demand, financing systems and payment mechanisms to service providers, public and private relations and their impact on equity in health. It also encompasses the managerial and clinical aspects evaluated in terms of effectiveness, safety and efficiency of healthcare, and also ensures the rights of patients and their participation in the process of healthcare and the humanization of care. In a book published to commemorate the fiftieth anniversary of the International Epidemiological Association (IEA), Kerr White recounts the long struggle of researchers to demonstrate the importance of Research into Health Services. In 1961, Kerr White published the classic article "The ecology of medical care" in The New England Journal of Medicine. His leadership in the first comparative survey on the use of health services, conducted in seven countries between 1964 and 1976, in collaboration with the WHO, should also be stressed. It is worth highlighting the major importance of this study for research into health services in South America, especially in Argentina, where its deployment has enabled the training of professionals in various specialized areas in the design, implementation and analysis of data from household health surveys. As reported in Mario Hamilton's recently published posthumous book, this study would have had a greater impact if his premature demise in 1973 had not occurred before he had completed analysis of the data.
Mechanisms for fostering research into healthcare services were developed in the U.S. and in some European countries. The output of research in this area saw a significant increase in these countries in the 1970s and 1980s in association with increased healthcare cover and the technological density of healthcare, with a marked impact on the costs of health systems and increasing doubts about their effectiveness.
Monitoring the performance of the Brazilian health system involves investment in the training of researchers, in conducting research and producing systematic population-based data. We need to know systematically what factors in our context facilitate or hinder people from obtaining the care that they need and that can benefit from, to redirect the paths and steer the system continuously in line with the principles of the Unified Health System (SUS). These are the objectives that underpinned the health supplements prepared with the cooperation of researchers from various areas of Public Health that accompanied the 1998, 2003 and 2008 National Household Health Surveys (PNAD). As in 2002 and 2006, Ciência e Saúde Coletiva publishes further articles that used data from the historic series of health supplements collected by the Brazilian Institute of Geography and Statistics (IBGE). We trust that the series of data generated by PNAD health supplements will have a promising future in order to maintain the focus on the results of health policies in Brazil.
Claudia Travassos, Francisco Viacava