Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis

Abstract

ObjectiveChile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population.MethodsUsing data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both “legitimate” standardizing variables (age and sex) and “illegitimate” variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement).ResultsThere was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.ConclusionsIncome-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey

“…where c is the concentration index, y i is the health sector variable of individual i, R i is the fractional ranks of income, and µ is the mean of y i . The health concentration index can be decomposed into the contributions of each determinant to observed income-related health inequality-in which, each contribution is the product of the sensitivity of health with respect to that determinant and the degree of income-related inequality in that determinant [28]. Health economists normally put forward the different decomposition methods in the literature to decompose the concentration index.…”

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis

“…This may have been due to other health sector-related reforms introduced before the TSL implementation, as well as the lack of proper implementation of the TSL and insufficient funds paid to the health system [ 18 ]. Another study reported that equity-based healthcare reform significantly reduced income-related inequality [ 38 ]. Moreover, studies have shown positive effects of economic or health system reforms on equity in healthcare financing [ 39 ].…”

Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China

“…The concentration index is between -1 and 1. A positive number indicates that the health variable is distributed toward the rich [ 21 ]. In the analysis, the health variable of interest is the occurrence of CHE.…”