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Horizontal Inequity in Access to Health Care in Four South American Cities

Author

Listed:
  • Ana Balsa

    (Health Economics Research Group, Department of Sociology, University of Miami)

  • Máximo Rossi

    (Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República)

  • Patricia Triunfo

    (Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la República)

Abstract

This paper analyzes and compares socioeconomic inequalities in the use of healthcare services by the elderly in four South-American cities: Buenos Aires, Santiago, Montevideo and San Pablo. We use data from SABE, a survey on Health, Well-being and Aging administered in 2000. After having accounted for socioeconomic inequalities in healthcare needs, we find socioeconomic inequities favoring the rich in the use of preventive services (mammograms, pap tests, breast examinations, and prostate exams) in all of the studied cities. We also find inequities in the likelihood of having a medical visit in Santiago and Montevideo, and in some measures of quality of access in Santiago, Sao Paulo, and Buenos Aires. Santiago depicts the highest inequities in medical visits and Uruguay the worse indicators in mammograms and pap scans tests. For all cities, inequities in preventive services at least double inequities in other services. We do not find evidence of a trade-off between levels of access and equity in access to healthcare services. The decomposition of healthcare inequalities suggests that inequities within each health system are more important than between systems.

Suggested Citation

  • Ana Balsa & Máximo Rossi & Patricia Triunfo, 2009. "Horizontal Inequity in Access to Health Care in Four South American Cities," Documentos de Trabajo (working papers) 1509, Department of Economics - dECON.
  • Handle: RePEc:ude:wpaper:1509
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    File URL: https://hdl.handle.net/20.500.12008/2132
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    References listed on IDEAS

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    1. 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 - Books, The World Bank Group, number 6896, December.
    2. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Inequalities in Health Care Utilization in Switzerland over Time," IZA Discussion Papers 1316, Institute of Labor Economics (IZA).
    3. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
    4. Morris, Stephen & Sutton, Matthew & Gravelle, Hugh, 2005. "Inequity and inequality in the use of health care in England: an empirical investigation," Social Science & Medicine, Elsevier, vol. 60(6), pages 1251-1266, March.
    5. Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related health inequalities in Switzerland over time," Diskussionsschriften dp0414, Universitaet Bern, Departement Volkswirtschaft.
    6. Pilar García‐Gómez & Erik Schokkaert & Tom Van Ourti & Teresa Bago d'Uva, 2015. "Inequity in the Face of Death," Health Economics, John Wiley & Sons, Ltd., vol. 24(10), pages 1348-1367, October.
    7. Mariana De Santis & Verónica Herrero, 2009. "Equidad en el Acceso, Desigualdad y Utilización de los Servicios de Salud. Una Aplicación al Caso Argentino en 2001," Revista de Economía y Estadística, Universidad Nacional de Córdoba, Facultad de Ciencias Económicas, Instituto de Economía y Finanzas, vol. 47(1), pages 125-162, Junio.
    8. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    9. VAN OURTI, Tom, 2002. "Measuring horizontal inequity in health care using Belgian panel data," Working Papers 2002034, University of Antwerp, Faculty of Business and Economics.
    10. Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related inequalities in health care utilization in Switzerland over time," Diskussionsschriften dp0413, Universitaet Bern, Departement Volkswirtschaft.
    11. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    12. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1989. "Equity in the Finance and Delivery of Health Care: Some Tentative Cross-country Comparisons," Oxford Review of Economic Policy, Oxford University Press, vol. 5(1), pages 89-112, Spring.
    13. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    14. Bertranou, Fabio M., 1999. "Are market-oriented health insurance reforms possible in Latin America?: The cases of Argentina, Chile and Colombia," Health Policy, Elsevier, vol. 47(1), pages 19-36, April.
    15. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819, October.
    16. van Doorslaer, Eddy & Wagstaff, Adam, 1992. "Equity in the delivery of health care: some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 389-411, December.
    17. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
    18. Leu, Robert E. & Schellhorn, Martin, 2004. "The Evolution of Income-Related Health Inequalities in Switzerland over Time," IZA Discussion Papers 1346, Institute of Labor Economics (IZA).
    19. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
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    Cited by:

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    2. Cecilia González & Patricia Triunfo, 2018. "Inequidad en el acceso a los servicios de salud en Uruguay," Documentos de Trabajo (working papers) 0718, Department of Economics - dECON.
    3. Shreya Banerjee & Indrani Roy Chowdhury, 2020. "Inequities in curative health-care utilization among the adult population (20–59 years) in India: A comparative analysis of NSS 71st (2014) and 75th (2017–18) rounds," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-23, November.
    4. Alfredo Palacios & Julia Gabosi & Caitlin Williams & Carlos Rojas-Roque, 2021. "Social vulnerability, exposure to environmental risk factors and accessibility to healthcare services: Evidence for 2,000+ slums and informal settlements in Argentina," Asociación Argentina de Economía Política: Working Papers 4502, Asociación Argentina de Economía Política.
    5. Sachita Nanda Sa & Mehajabin Firdosh, 2021. "Impact of Health Seeking Behaviour on Morbidity Pattern and Health Service Utilization among Muslim Women: A Case Study of Balasore Municipalty, Odisha," Journal of Studies in Dynamics and Change (JSDC), ISSN: 2348-7038, Voices of Inclusive Change and Expressions- (VOICE) Trust, Dehradun, Uttarakhand, vol. 8(2), pages 25-39, April-Jun.

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    More about this item

    Keywords

    inequalities; healthcare; medical visit; preventive services;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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