Income-related health inequality in Portugal

The Portuguese health care system is based on principles of equity and efficiency. Despite that, it appears that equality has not been fully realized owing to differences in access [Dixon and Massialos (2000)] or self-assessed health [Van Doorslaer and Koolman (2004)]. The purpose of this study is to evaluate the degree of income-related inequality in self-reported health in Portugal using different database and methods than those used by Van Doorslaer and Koolman (2004). This study applies the methods developed by Wagstaff and Van Doorslaer (1994) to measure the degree of income-related inequality in self-reported health by means of concentration indices. The results show that significant inequalities in self-reported ill-health exist and favour groups with higher income. Nonetheless, when compared with a similar study [Van Doorslaer et al. (1997)], the estimates for income related inequality suggest that Portugal in 1998/1999 ranks in the middle of the European countries. The most important contributors to health inequality are income, activity status and education. Regional differences, by contrast, do not exert any systematic influence. Reductions in pro-rich health inequality can be achieved by reducing the effect of income on health or reducing income inequality, or both.