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Perfil dos utentes e consumos de uma instituição de saúde privada
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RESUMO - Introdução: Nas últimas décadas, o setor da saúde em Portugal tem atravessado profundas transformações demográficas e estruturais, marcadas pelo envelhecimento da população, aumento das doenças crónicas e crescente procura de cuidados no setor privado. Apesar da universalidade do SNS, os pagamentos diretos das famílias têm aumentado. A adesão a seguros de saúde privados e subsistemas tem crescido de forma expressiva. O presente trabalho tem como objetivo compreender os perfis dos utentes que recorrem ao setor privado, as suas formas de financiamento, analisando os níveis de copagamento e valores médios pagos.
Métodos: Foi desenvolvido um estudo ecológico analítico retrospetivo através do qual foram analisados os episódios não pediátricos, em ambulatório ocorridos numa instituição privada na AML, em 2023. Inicialmente realizou-se a caracterização do perfil do utente por faixa etária, sexo e entidade financiadora mais utilizada. Posteriormente foi analisada a associação entre a faixa etária e a entidade financiadora mais utilizada, bem como o valor médio pago por utente, por entidade, total e a percentagem de copagamento por entidade. Por fim, realizou-se a análise dos fatores associados ao valor total pago por utente.
Resultados: No ano de 2023 foram atendidos em ambulatório 68 361 utentes, dos quais 60,2% eram do sexo feminino. O SNS e a ADSE foram as entidades financiadoras mais utilizadas. A análise revelou diferenças estatisticamente significativas associadas ao sexo, idade e tipo de entidade financiadora no valor total pago por utente. Os utentes cuja entidade financiadora foi a ADSE apresentaram o copagamento mais reduzido (27%), enquanto as entidades financiadoras privadas registaram encargos médios superiores a 70%.
Conclusão: Este estudo mostra que existem diferenças no perfil, nas entidades financiadoras mais utilizadas e nos níveis de copagamento dos utentes que frequentam a instituição de saúde em estudo.
ABSTRACT - Introduction: In recent decades, the health sector in Portugal has undergone profound demographic and structural transformations, marked by population ageing, the growing prevalence of chronic diseases, and an increasing demand for healthcare services in the private sector. Despite the universality of the National Health Service (NHS), out-of-pocket household payments have been rising. The uptake of private health insurance and occupational health subsystems has also grown significantly. This study aims to understand the profiles of users who resort to the private sector and their modes of financing, analysing the levels of cost-sharing and the average amounts paid. Methods: An analytical retrospective ecological study was conducted to analyse non-paediatric outpatient episodes that occurred in a private healthcare institution in the Lisbon Metropolitan Area (AML) in 2023. Initially, patients were characterised by age group, sex, and the most frequently used financing entity. Subsequently, the association between age group and the main financing entity was examined, as well as the average amount paid per user, by entity and in total, and the percentage of cost-sharing by entity. Finally, factors associated with the total amount paid by each user were analysed. Results: In 2023, a total of 68,361 outpatients were treated, of whom 60.2% were female. The National Health Service (NHS) and ADSE were the most frequently used financing entities. The analysis revealed statistically significant differences in the total amount paid per user, associated with sex, age, and type of financing entity. Users whose financing entity was ADSE showed the lowest cost-sharing level (27%), while those covered by private financing entities recorded average out-of-pocket expenses exceeding 70%. Conclusion: This study shows that there are differences in the profile, the most frequently used financing entities, and the levels of cost-sharing among users attending the healthcare institution under study.
ABSTRACT - Introduction: In recent decades, the health sector in Portugal has undergone profound demographic and structural transformations, marked by population ageing, the growing prevalence of chronic diseases, and an increasing demand for healthcare services in the private sector. Despite the universality of the National Health Service (NHS), out-of-pocket household payments have been rising. The uptake of private health insurance and occupational health subsystems has also grown significantly. This study aims to understand the profiles of users who resort to the private sector and their modes of financing, analysing the levels of cost-sharing and the average amounts paid. Methods: An analytical retrospective ecological study was conducted to analyse non-paediatric outpatient episodes that occurred in a private healthcare institution in the Lisbon Metropolitan Area (AML) in 2023. Initially, patients were characterised by age group, sex, and the most frequently used financing entity. Subsequently, the association between age group and the main financing entity was examined, as well as the average amount paid per user, by entity and in total, and the percentage of cost-sharing by entity. Finally, factors associated with the total amount paid by each user were analysed. Results: In 2023, a total of 68,361 outpatients were treated, of whom 60.2% were female. The National Health Service (NHS) and ADSE were the most frequently used financing entities. The analysis revealed statistically significant differences in the total amount paid per user, associated with sex, age, and type of financing entity. Users whose financing entity was ADSE showed the lowest cost-sharing level (27%), while those covered by private financing entities recorded average out-of-pocket expenses exceeding 70%. Conclusion: This study shows that there are differences in the profile, the most frequently used financing entities, and the levels of cost-sharing among users attending the healthcare institution under study.
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Serviços de saúde privados Perfil do utente Entidade financiadora Copagamento Private healthcare services Patient profile Funding entity Copayment