National Policy on Health Care Hearing: an evaluative study from covering services and diagnostic procedures

Purpose: To evaluate the National Policy on Hearing Health Care (PNASA) based on the coverage of specialized services and diagnostic procedures in hearing health care in Brazil. Methods: This is an evaluation study focused on the coverage of specialized services that offer moderate-and high-complexity diagnostic procedures by region and in Brazil as a whole. We analyzed the data for the period of 2004-2011 collected from the Unified Health System's Informatics Department database (DATASUS), under the link "Information on health" and tabulated using the software Tabwin. While collecting data from this platform, we selected "procedures for diagnostic purposes", and the selected way of organization was "diagnoses in otorhinolaryngology/audiology" of moderate and high complexity. We estimated coverage and evolution of the number of procedures according to the country's five geographic macroregions. Results: We identified an increase of 113% in service coverage and of 61% in the quantity of moderate-and high-complexity hearing health diagnostic procedures throughout the country. The northern region had an increase of 78% in the number of procedures, higher than all other regions. However, a proportionally larger number of procedures were performed in the southeast. We identified a significant increase in the number of examinations of otoacoustic emissions (OAE) for hearing triage, transient-evoked OAE and distortion product, as well as of diagnostic reassessments of hearing loss in patients older than 3 years. Conclusion: There has been an increase in services and actions in hearing health care in Brazil since PNASA was implemented, but regional inequalities in the distribution of these services still persist.