Racial inequalities in access to healthcare services in Brazil (2019): a decomposition analysis
File(s)
Published version
Author(s)
Coelho, Rony
Mrejen, Matias
Falcao, Lucas
Rocha, Rudi
Hone, Thomas
Type
Journal Article
Abstract
Background: Racial and ethnic inequalities in access to healthcare services pose a significant challenge for many countries, with ethnic minorities and Afro-descendants frequently experiencing poorer access to services and health outcomes. However, little is known about the factors that drive racial inequalities in access to healthcare, especially in low- and middle-income countries.
Methods: This is a cross-sectional, observational study that uses data from the National Health Survey (2019) in Brazil and assesses the contribution of predisposing, facilitating, and need-for-care factors to inequalities in healthcare access between White, Black and Pardo (Brown) Brazilians. The Oaxaca-Blinder method was used to separate differences between racial groups into explained and unexplained determinants. Variables included in the models were age, sex, marital status, family size and composition, access to sanitation, health insurance, primary care coverage, income quintile, employment status, education, and self-rated health status.
Results: The responses from 204,918 individuals were analysed. White Brazilians reported better access to healthcare and medications than Black or Pardo Brazilians, with the largest racial inequalities in unmet needs for healthcare services and access to medication. Racial inequalities are mostly explained by observable factors (between 35% and 87%), most notably the access to financial resources (income and access to private health insurance). Being covered by the Family Health Program and higher levels of education were associated with reduced inequalities between racial groups. The unexplained portion of inequalities was the greatest when comparing Black and White individuals, implying that factors beyond socioeconomic status likely drive these inequalities including community, cultural or behavioural factors, and inequalities and bias in healthcare services.
Conclusions: While investments in universal healthcare and education may be important for reducing racial inequalities in access to healthcare, better understanding of cultural and contextual factors and targeted public policies and services interventions for addressing racial inequalities are needed.
Methods: This is a cross-sectional, observational study that uses data from the National Health Survey (2019) in Brazil and assesses the contribution of predisposing, facilitating, and need-for-care factors to inequalities in healthcare access between White, Black and Pardo (Brown) Brazilians. The Oaxaca-Blinder method was used to separate differences between racial groups into explained and unexplained determinants. Variables included in the models were age, sex, marital status, family size and composition, access to sanitation, health insurance, primary care coverage, income quintile, employment status, education, and self-rated health status.
Results: The responses from 204,918 individuals were analysed. White Brazilians reported better access to healthcare and medications than Black or Pardo Brazilians, with the largest racial inequalities in unmet needs for healthcare services and access to medication. Racial inequalities are mostly explained by observable factors (between 35% and 87%), most notably the access to financial resources (income and access to private health insurance). Being covered by the Family Health Program and higher levels of education were associated with reduced inequalities between racial groups. The unexplained portion of inequalities was the greatest when comparing Black and White individuals, implying that factors beyond socioeconomic status likely drive these inequalities including community, cultural or behavioural factors, and inequalities and bias in healthcare services.
Conclusions: While investments in universal healthcare and education may be important for reducing racial inequalities in access to healthcare, better understanding of cultural and contextual factors and targeted public policies and services interventions for addressing racial inequalities are needed.
Date Issued
2025-12-05
Date Acceptance
2025-09-16
Citation
BMC Health Services Research, 2025, 25 (1)
ISSN
1472-6963
Publisher
BMC
Journal / Book Title
BMC Health Services Research
Volume
25
Issue
1
Copyright Statement
© 2025 The Author(s). This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s12913-025-13527-6
Subjects
Racial inequalities
Healthcare access
Socioeconomic factors
Discrimination
Publication Status
Published
Article Number
ARTN 1573