Measurement and determinants of inequalities in healthcare utilization: an analysis for the Brazilian regions
Please cite the paper as:
“Jacqueline N. Cambota and Fabiana F. Rocha, (2014), Measurement and determinants of inequalities in healthcare utilization: an analysis for the Brazilian regions, World Economics Association (WEA) Conferences, No. 1 2014, Is a more inclusive and sustainable development possible in Brazil?, 5th May to 12th August 2014”
The aim of this paper is to measure and explain income-related inequality in healthcare utilization for Brazilian regions. Firstly, inequality was estimated by two measures: concentration index and horizontal inequality index. The first index reflects income-related inequalities, but does not distinguish the differences in utilization by healthcare needs. The horizontal inequality index, in turn, measures income-related inequality among individuals with similar needs. Thus, the results indicate horizontal pro-rich inequity in the utilization of doctor visits and a greater degree of inequity in the North and Northeast of Brazil. On the other hand, there is no evidence of inequity in hospital care utilization. Then, we proceeded to the decomposition of inequality based on utilization determinants. The results of the decomposition analysis showed that contributions of need determinants are mostly pro-poor and that contributions of social determinants are more diversified. Income, education, and health insurance contributed to increasing the pro-rich distribution of doctor visits and reducing the distribution of pro-poor inpatient care, while activity status contributions were mostly pro-poor because the opportunity cost of seeking healthcare is higher among economically active people.
In the last paragraph you wrote: “In this respect, contributions to the utilization of health insurance plans and of the place of residence by the rich in Brazil could be reduced, for instance, by a healthcare coverage focused on low-income people and by the higher supply of physical and human resources to areas where health services are scarce”.
I would like you to explore the rationale of the health policies that have been adopted in Brazil in the last decade in order to make clearer the changes that would arise from the policy proposal presented in the conclusions.