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Inpatient care of the elderly in Brazil and India: Assessing social inequalities

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  • Channon, Andrew Amos
  • Andrade, Monica Viegas
  • Noronha, Kenya
  • Leone, Tiziana
  • Dilip, T.R.
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    Abstract

    The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 75 (2012)
    Issue (Month): 12 ()
    Pages: 2394-2402

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    Handle: RePEc:eee:socmed:v:75:y:2012:i:12:p:2394-2402

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    Related research

    Keywords: Inpatient; Brazil; India; Inequalities; Health system;

    References

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    1. Kenya Valeria Micaela de Souza Noronha & Mônica Viegas Andrade, 2002. "Social inequality in the access to healthcare services in Brazil," Textos para Discussão Cedeplar-UFMG td172, Cedeplar, Universidade Federal de Minas Gerais.
    2. Yuki Murakami & Andreas Blom, 2008. "Accessibility and Affordability of Tertiary Education in Brazil, Colombia, Mexico and Peru within a Global Context," World Bank Other Operational Studies 10282, The World Bank.
    3. David E. Bloom & Ajay Mahal & Larry Rosenberg & Jaypee Sevilla, 2010. "Economic security arrangements in the context of population ageing in India," PGDA Working Papers 6010, Program on the Global Demography of Aging.
    4. Murakami, Yuki & Blom, Andreas, 2008. "Accessibility and affordability of tertiary education in Brazil, Colombia, Mexico and Peru within a global context," Policy Research Working Paper Series 4517, The World Bank.
    5. de Carvalho Filho, Irineu Evangelista, 2008. "Old-age benefits and retirement decisions of rural elderly in Brazil," Journal of Development Economics, Elsevier, vol. 86(1), pages 129-146, April.
    6. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications, The World Bank, number 6896, October.
    7. Grundy, Emily & Sloggett, Andy, 2003. "Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances," Social Science & Medicine, Elsevier, vol. 56(5), pages 935-947, March.
    8. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, vol. 53(9), pages 1149-1162, November.
    9. Roy, Kakoli & Chaudhuri, Anoshua, 2008. "Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India," Social Science & Medicine, Elsevier, vol. 66(9), pages 1951-1962, May.
    10. Mullahy, John, 1986. "Specification and testing of some modified count data models," Journal of Econometrics, Elsevier, vol. 33(3), pages 341-365, December.
    11. Owen O'Donnell & Eddy van Doorslaer & Ravi P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Deni Harbianto & Charu C. Garg & Piya Hanvoravongchai & Mohammed N. Huq & Anup Karan & Gabriel M., 2007. "The Incidence of Public Spending on Healthcare: Comparative Evidence from Asia," World Bank Economic Review, World Bank Group, vol. 21(1), pages 93-123.
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