Abstract
This study focuses on the Unified Health System (SUS) in five regions of the state of Rio de Janeiro, Brazil, one of Brazil's most important states, as part of a comprehensive analysis of a research project, which has generated publications in earlier phases. The objective was to assess users' perceptions of SUS in terms of access to and the quality of public health services, including primary care and pharmaceutical services. A cross-sectional study was conducted using a structured questionnaire comprising 66 questions, administered to a purposive sample of 1000 participants between August 2023 and August 2024. Data were analyzed using Pearson's chi-square test with R software version 4.3. Among the participants, 54.5% were female, 62.5% were aged between 26 and 60 years, and 29% reported having private health insurance. Vaccination services were the most frequently used SUS service (25.1% of respondents). Participants who reported more frequent use of SUS services rated access more positively than those who used them less frequently (p = 0.002). The regions that evaluated SUS access and quality most favorably were Middle Paraíba and the metropolitan region, while the Coastal Lowlands region received the most negative assessments. Participants with lower socioeconomic status gave more favorable evaluations of access to public health services (p = 0.001). These findings highlight concerns about access to, and the quality of, SUS healthcare services and regional disparities in users' perceptions of SUS services in Rio de Janeiro. The results underscore the importance of social participation as a key element in the evaluation and continuous improvement of responsive public healthcare.