Inequality in access to health services between urban and rural areas in Brazil: a disaggregation of factors from 1998 to 2008

Access to healthcare is an important dimension of inequalities between urban and rural areas. Access is lower in rural areas due to the population's greater social vulnerability and greater difficulties in access among its social groups. Based on data from the health supplement of the Brazilian National Household Sample Survey, we analyzed the determinants of access and differences between urban and rural areas from 1998 to 2008. The analysis of determinants of access to health services used binary logistic regression. Differences between urban and rural areas were disaggregated as observable factors (enabling, need, and predisposing) and non-observable factors (supply and difficulty in access). The results highlight that inequality in access is higher in rural areas. Need factors are fundamental determinants of access to health, while enabling factor are more important for explaining the differences between urban and rural areas. The slight reduction in differences during the period was due mainly to changes in the rural population's composition.