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Avaliações subjectivas sobre qualidade em saúde: um contributo para o estudo da equidade
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Orientador(es)
Resumo(s)
RESUMO - A equidade em saúde é normalmente encarada como justiça
na obtenção, uso e acesso dos cidadãos aos cuidados de
saúde. Em nosso entender, este conceito pode e deve ser
estendido para abranger outros aspectos da relação dos
cidadãos com o sistema de saúde, nomeadamente a forma
como são recebidos e tratados técnica e humanamente
pelas instituições. A avaliação da satisfação que os cidadãos
manifestam após uma experiência de prestação de cuidados
é assim reveladora da percepção dessa equidade.
No entanto, tratamento igual pode ser avaliado pelos doentes
com diferentes valores de satisfação. Isto deve-se principalmente
à relação existente entre as características dos
doentes e as escalas usadas por eles na avaliação.
O objectivo deste artigo é contribuir para a constatação de
que as pontuações fornecidas pelos doentes, quando é avaliada
a sua satisfação, são sensíveis às características pessoais,
como o grupo etário, o sexo, as habilitações e o rendimento.
Com a ajuda de vários milhares de respostas de satisfação
dos doentes, aplicámos modelos probit ordenados com pontos
de corte variáveis. Neste estudo, estes pontos de corte
são função das características pessoais dos doentes.
De entre as principais conclusões que pudemos retirar da
utilização do modelo probit ordenado, podemos referir que
as pessoas mais velhas são menos exigentes face ao sistema
de cuidados, assim como os homens e doentes com menos
habilitações. Este último enquadramento não tem em conta
as diferentes expectativas que as pessoas têm. No entanto,
um modelo probit ordenado generalizado permite analisar
o impacto das diferentes escalas (expectativas) nas pontuações
finais.
Concluindo, os valores obtidos nos questionários de satisfação
devem ser ponderados de modo a serem comparados e
usados pelos profissionais de saúde para uma melhor avaliação
da equidade.
ABSTRACT - Equity in health is usually seen by citizens as justice in the attainment, use and access of health care. In our understanding, the meaning of this concept may and should include other aspects about the relationship of the citizens with the health system, e. g., the way they are received and treated technically and humanly by the health care settings. The assessments of the satisfaction citizen have after experiencing the provision of care is revealing of their perception of equity. However, equal treatment may be assessed by patients with different satisfaction scores. This is mainly due to the relationship between the patients’ personal characteristics and the scales actually used by them in the assessments. The current paper aims at contributing to the evidence that the scores provided by patients when assessing their own satisfaction are sensitive to personal characteristics such as age group, gender, education and income. Based on several thousands of patients’ satisfaction answers, we estimated ordered probit models with variable thresholds. In this study, these thresholds were a function of the patients’ personal characteristics. Among the main conclusions we were able to withdraw from the utilization of the ordered probit model, we may state that older people are less demanding regarding the health care system, as well as, men and less educated patients. This last framework does not take into account the different expectations people have. However, a generalized ordered probit model allows us to analyze the impact of different scales (expectations) in the final scores. Summarizing, the scores obtained from satisfaction questionnaires, should be weighted in order to be able to be comparable and used by health professionals towards a better equity.
ABSTRACT - Equity in health is usually seen by citizens as justice in the attainment, use and access of health care. In our understanding, the meaning of this concept may and should include other aspects about the relationship of the citizens with the health system, e. g., the way they are received and treated technically and humanly by the health care settings. The assessments of the satisfaction citizen have after experiencing the provision of care is revealing of their perception of equity. However, equal treatment may be assessed by patients with different satisfaction scores. This is mainly due to the relationship between the patients’ personal characteristics and the scales actually used by them in the assessments. The current paper aims at contributing to the evidence that the scores provided by patients when assessing their own satisfaction are sensitive to personal characteristics such as age group, gender, education and income. Based on several thousands of patients’ satisfaction answers, we estimated ordered probit models with variable thresholds. In this study, these thresholds were a function of the patients’ personal characteristics. Among the main conclusions we were able to withdraw from the utilization of the ordered probit model, we may state that older people are less demanding regarding the health care system, as well as, men and less educated patients. This last framework does not take into account the different expectations people have. However, a generalized ordered probit model allows us to analyze the impact of different scales (expectations) in the final scores. Summarizing, the scores obtained from satisfaction questionnaires, should be weighted in order to be able to be comparable and used by health professionals towards a better equity.
Descrição
Palavras-chave
avaliação auto-relatada equidade satisfação qualidade de cuidados
Contexto Educativo
Citação
Ferreira, Pedro Lopes; Lourenço, Óscar Domingos - Avaliações subjectivas sobre qualidade em saúde : um contributo para o estudo da equidade = Subjective assessments about quality : contribution to studies of equity. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Volume temático, Nº 3 (2003), p. 81-91
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública