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

Cabieses B, Cookson R, Espinoza M, Santorelli G, Delgado I - PLoS ONE (2015)

Bottom Line: Chile, 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.There 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).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.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine Clínica Alemana, Universidad del Desarrollo, Chile, Av. La Plaza 680, Las Condes, Santiago, Chile; Department of Health Sciences, University of York, Heslington, York, England, United Kingdom.

ABSTRACT

Objective: Chile, 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.

Methods: Using 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).

Results: There 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.

Conclusions: Income-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.

No MeSH data available.


Related in: MedlinePlus

Concentration curves for SRHS in Chile before (2000) and after (2013) the healthcare reform in Chile of 2005.
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pone.0138227.g003: Concentration curves for SRHS in Chile before (2000) and after (2013) the healthcare reform in Chile of 2005.

Mentions: Fig 3 displays the concentration curves for income related SRHS in years 2000 and 2013. Table 4 presents the results of the CI estimation for years 2000 and 2013 using different analytical methods. In year 2000, the uncorrected CI for SRHS in Chile by convenient regression method was 0.062 [SE = 0.0028]. The same measure in 2013 was 0.018 (SE = 0.0016). The corrected Erreygers CI estimation showed a positive value of 0.165 [SE = 0.0075] in 2000 and 0.047 [SE = 0.0088] in 2013. Despite some variation, all CIs values indicated that better health status was concentrated among the rich in Chile both before and after the equity-centered reform of 2005. Similar to the findings from the previous comparisons, this also suggests that inequality has decreased over time. Nevertheless, it should be noted that CI values are not on a ratio scale and therefore interpretation of the magnitude of change must be cautious.


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

Cabieses B, Cookson R, Espinoza M, Santorelli G, Delgado I - PLoS ONE (2015)

Concentration curves for SRHS in Chile before (2000) and after (2013) the healthcare reform in Chile of 2005.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587959&req=5

pone.0138227.g003: Concentration curves for SRHS in Chile before (2000) and after (2013) the healthcare reform in Chile of 2005.
Mentions: Fig 3 displays the concentration curves for income related SRHS in years 2000 and 2013. Table 4 presents the results of the CI estimation for years 2000 and 2013 using different analytical methods. In year 2000, the uncorrected CI for SRHS in Chile by convenient regression method was 0.062 [SE = 0.0028]. The same measure in 2013 was 0.018 (SE = 0.0016). The corrected Erreygers CI estimation showed a positive value of 0.165 [SE = 0.0075] in 2000 and 0.047 [SE = 0.0088] in 2013. Despite some variation, all CIs values indicated that better health status was concentrated among the rich in Chile both before and after the equity-centered reform of 2005. Similar to the findings from the previous comparisons, this also suggests that inequality has decreased over time. Nevertheless, it should be noted that CI values are not on a ratio scale and therefore interpretation of the magnitude of change must be cautious.

Bottom Line: Chile, 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.There 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).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.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Medicine Clínica Alemana, Universidad del Desarrollo, Chile, Av. La Plaza 680, Las Condes, Santiago, Chile; Department of Health Sciences, University of York, Heslington, York, England, United Kingdom.

ABSTRACT

Objective: Chile, 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.

Methods: Using 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).

Results: There 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.

Conclusions: Income-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.

No MeSH data available.


Related in: MedlinePlus