Subjective evaluation and utilization of hospitals by low-income urban residents in Porto Alegre, Brazil

Abstract

Subjective evaluations of alternative general hospitals, by residents of a lower socioeconomic status community in Porto Alegre, Brazil, are analyzed to explain hospital selection. The study is based on consumer spatial behavior research in geography. Thirty-six hospital attributes are identified through a triadic procedure applied to residents in their homes. Subsequently, the seven hospitals most widely known by the community are evaluated, using the elicited attributes and a one-to-seven scale, by all members of three random stratified samples of approximately 45 people each. Four similar important dimensions of hospital differentiation and evaluation are identified through the use of J. Douglas Carroll's INDSCAL model. A clear pattern of perceived relative utility of alternative hospitals, based on the four dimensions, is exhibited by the residents. However, utilization among alternative hospitals is found to be negatively correlated with expressed preferences. The power of community residents to choose is significantly limited through institutional and cultural, rather than financial, constraints. Community residents use hospitals of perceived lower ‘quality’ rather than more proximate, perceived higher ‘quality’ hospitals.