IDEAS home Printed from https://ideas.repec.org/p/ude/wpaper/1509.html
   My bibliography  Save this paper

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
    as

    Download full text from publisher

    File URL: https://hdl.handle.net/20.500.12008/2132
    Download Restriction: no
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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 and Oxford Review of Economic Policy Limited, vol. 5(1), pages 89-112, Spring.
    6. 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.
    7. 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).
    8. 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.
    9. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
    10. 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.
    11. 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.
    12. Robert E. Leu & Martin Schellhorn, 2004. "The evolution of income-related health inequalities in Switzerland over time," Diskussionsschriften dp0414, Universitaet Bern, Departement Volkswirtschaft.
    13. 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.
    14. 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.
    15. 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.
    16. 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.
    17. 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).
    18. 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.
    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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Fiorillo Damiano & Sabatini Fabio, 2011. "Quality and quantity: The role of social interactions in individual health," wp.comunite 0073, Department of Communication, University of Teramo.
    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    2. Tavares, Lara Patrício & Zantomio, Francesca, 2017. "Inequity in healthcare use among older people after 2008: The case of southern European countries," Health Policy, Elsevier, vol. 121(10), pages 1063-1071.
    3. Tom Van Ourti, 2004. "Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 705-724, July.
    4. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    5. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    6. Laudicella, Mauro & Cookson, Richard & Jones, Andrew M. & Rice, Nigel, 2009. "Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS," Journal of Health Economics, Elsevier, vol. 28(6), pages 1048-1061, December.
    7. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    8. 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.
    9. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    10. Mª Luz González Alvarez & Antonio Clavero Barranquero, 2008. "An analysis of income-related inequalities in the health care use by dynamic models," Hacienda Pública Española / Review of Public Economics, IEF, vol. 186(3), pages 9-42, October.
    11. Bilger, Marcel, 2008. "Progressivity, horizontal inequality and reranking caused by health system financing: A decomposition analysis for Switzerland," Journal of Health Economics, Elsevier, vol. 27(6), pages 1582-1593, December.
    12. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    13. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Inequity in physician visits: the case of the unregulated fee market in Australia," Social Science & Medicine, Elsevier, vol. 255(C).
    14. dos Santos, Anderson Moreira Aristides & Triaca, Lívia Madeira & Tejada, Cesar Augusto Oviedo, 2021. "Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019," The Journal of the Economics of Ageing, Elsevier, vol. 20(C).
    15. Marta González-Touya & Alexandrina Stoyanova & Rosa M. Urbanos-Garrido, 2021. "COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?," IJERPH, MDPI, vol. 18(17), pages 1-15, August.
    16. Magnus Lindelow, 2006. "Sometimes more equal than others: how health inequalities depend on the choice of welfare indicator," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 263-279, March.
    17. Carrieri, V. & Wuebker, A., 2012. "Assessing inequalities in preventive care use in Europe: A special case of health-care inequalities?," Health, Econometrics and Data Group (HEDG) Working Papers 12/25, HEDG, c/o Department of Economics, University of York.
    18. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    19. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    20. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 255-266, June.

    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

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ude:wpaper:1509. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Andrea Doneschi or the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/derauuy.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.