ABSTRACT:
Context: This study is based on the ISA-Capital, a population-based health survey and analyzes the use and access to health services, based on an analysis of regional and generational inequalities related to health insurance coverage.

OBJECTIVES:
To analyze regional and generational inequalities in access to and use of outpatient health services within the Unified Health System (SUS) in the city of São Paulo in 2024.

METHODS:
Data were extracted from representative samples of adolescents, adults, and older adults (10 years or older) participating in a population-based health survey conducted in São Paulo (ISA-Capital) in 2024 (n=5472). Outcomes included the use of health services in the past year and private health insurance. Prevalence estimates and 95% confidence intervals (95% CI) were calculated.

RESULTS:
In 2024, 37.8% (95% CI: 33.6% - 42.2%) of the population had private health insurance. Coverage was 43.4% (38.2% - 48.8%) among the elderly and 32.2% (27.3% - 37.5%) among adolescents. Regarding service utilization, 85.0% (83.0% - 86.9%) of the total population had a consultation in the last year, with rates of 92.0% (89.9% - 93.6%) among the elderly and 82.6% (79.2% - 85.6%) among adolescents. Of those who had a consultation, 57.3% (52.6% - 61.8%) used the Unified Health System (SUS). This proportion was 65.7% (59.7% - 71.2%) among adolescents and 54.7% among the elderly. 30.9% (21.5% - 42.3%) in the Central Region and 69.6% (58.7% - 78.7%) in the Southern Region.

CONCLUSIONS:
The study identifies significant use of the SUS, with regional and generational inequalities, smaller in regions with smaller populations with private health insurance, such as the elderly population and the population of the Central Regional Health. The study provides important evidence and indicates the relevance of the SUS in promoting equity in public policies that guarantee access to health services.