Determining inequalities in health care use: analysis for Brazil and regions

Abstract

The aim of this paper is to measure and explain income-related inequalities in health care utilization (doctor visits and hospitalization) and establish which factors contributed to increase or decrease inequality in health care using data from Pnad 2008. Initially no-standardized and need-standardized concentration indices (horizontal inequity index) were built for Brazil and its regions. The results indicate pro-rich inequity in the utilization of doctor visits and a greater degree of inequity in the North and Northeast regions. On the other hand, there is no evidence of inequity in hospital care utilization. The decomposition analysis shows that the contributions of need determinants are mostly pro-poor, while the contributions of social determinants are more diversified. Income, education, and health insurance contribute to increase the pro-rich distribution of doctor visits and reduce the distribution of pro-poor hospital care. The work activity status contributions are mostly pro-poor since the opportunity cost of seeking healthcare is higher among the economically active.