Multiple inequity in health care: An example from Brazil

Barbosa, Estela Capelas; Cookson, Richard

doi:10.1016/j.socscimed.2019.02.034

Cited by 39 publications

(40 citation statements)

References 31 publications

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“…In most cases the complete ICL remains when one restricts attention to publicly funded health care alone. [44][45][46] Though there are exceptions among upper-middle income countries, including Cuba 47 , which introduced single payer health coverage in 1959, and countries that started introducing universal health coverage more recently such as Brazil (since 1988) 48 and Thailand (since 2002) 49 . By contrast, a DCL operates in almost all high-income countries, which usually have integrated systems of universal coverage -either single payer or heavily regulated multipayer with limited divergence between health insurance plans -and a small (< 30%) private expenditure share.…”

Section: Cross-country Comparisons Of Social Inequality In Health Care Deliverymentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the health inequality reduction objective is kept in sight.

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Section: Cross-country Comparisons Of Social Inequality In Health Care Deliverymentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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“…It also showed that the poor is facing worse health situations and they require more urgent health services than the rich [ 16 ]. Barbosa used the multivariate inequity to analyze the utilization of physician service in Brazil, and found that health insurance coverage and urban location both contribute more to the pro-rich inequity than income [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Liu

Cheng

et al. 2021

BMC Public Health

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Background Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. Methods The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. Results In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient). Conclusion There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

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“…Few studies have examined populations other than young children. We also note the work of Barbosa & Cookson (2019), who provide evidence of unfair inequalities in relation to visiting a doctor in Brazil. The impact of social and family background on the use of healthcare is also studied by Bricard (2013).…”

Section: Risk Of Social Exclusion and Resources Of Young Neetsmentioning

confidence: 88%

“…For those who are employed, the main financial resource is their salary but, as young people are at the beginning of their careers, this salary is not stable and it is therefore also not a good indicator of standard of living. These results therefore show the importance of considering sources of horizontal inequity in access to healthcare, without remaining restricted, as analyses that use concentration indices (Barbosa & Cookson, 2019) are, to inequalities in use throughout the distribution of incomes.…”

Section: * * *mentioning

confidence: 91%