Access to, use of and satisfaction with health services among adults enrolled in Brazil's Family Health Strategy: Evidence from the 2008 National Household Survey

Objective To assess the effects of participation in Brazil's primary healthcare programme (the Family Health Strategy or FHS) on access, use and satisfaction with health services among adults. Methods Data are from the 2008 National Household Survey (PNAD) on 264754 adults. This cross-sectional analysis compares FHS enrollees to both non-enrollees and those with private health plans. We calculated predicted probabilities of each outcome stratified by household wealth quintile, rural/urban location and sex using robust Poisson regression. We performed propensity score analysis to assess the differences in access among FHS enrollees and the rest of the population, once relevant socio-demographic characteristics and other determinants of access were balanced. Results Compared to families with neither FHS enrolment nor private health plans, adult FHS enrollees were generally more likely to have a usual source of care, to have visited a doctor or dentist in the past 12months, to have access to needed medications and to be satisfied with the care they received. The FHS effect was largest among urban dwellers and the poorest. Conclusions The FHS appears to be associated with enhanced access to and utilization of health services in Brazil. However, it has not yet been able to match levels of access experienced by those with private health plans, perhaps because the population served by the FHS is among the poorest, most rural and least healthy in the country.