Inequalities in the access to medical specialty appointments in the city of São Paulo, Brazil, 2005

The computerized appointment call center system aims to organize and optimize access to specialties appointments, strengthening the role of primary care as the entry to the Unified Health System. In the city of São Paulo, patients make appointments through one of the 422 outpatient units. This study aims to assess the distribution and utilization of openings for new appointments in specialties in São Paulo’s State Health Department. The information was extracted from the call center database and analyzed by the five regions of the city. The need for specialty appointments was calculated based on decree 1101/02 of the Ministry of Health, which corresponds to 22% of the total estimated medical appointments per inhabitant/year. 228,203 appointments were made available, 13.4% for the center-west region, matching 5.6% of its needs; 24.5% for the north, matching 5.9%; 26.1% for the east, matching 5.5%; 14.3% for the southeast, matching 3.0%, and 21.7% for the south, matching 4.6%. 178,054 appointments were scheduled, 21.2% by the center-west region; 29.8% by the north; 16.3% by the east; 11.4% by the southeast, and 21.3% by the south. The percentage of utilization by the regions was 123.2% in the center-west; 94.7% in the north; 49.6% in the east; 62.6% in the southeast, and 76.6% in the south. The openings for specialty medical appointments were equally distributed among regions, although the needs of the southeast were lower, because it has a federal specialty outpatient clinic. The east region, with the lowest HDI, poor geographical access and less human and material resources did not take advantage of the 50.4% appointments available, while the center-west, with the opposite profile, surpassed its offer, showing inequality among regions’ utilization of the scheduling system, which mirrors social inequality. It’s necessary to give proper conditions to all regions for the best appointment´s utilization.