Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition

Abstract

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

PIP: This paper summarizes results from eight country studies of inequality in the health sector. The analyses included household data to examine the distribution of service use and health expenditures. In each case, the results were presented by income quintiles, estimated using consumption expenditures. Results revealed that the rich groups have a higher probability of obtaining care when sick, to be more likely to be seen by physicians, and have a higher probability of receiving medicines, than the poor groups. The rich also spend more in absolute terms on care. There was no consistent pattern in the use of private providers. Wealthier households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicated that intuition concerning inequalities could result in misguided decisions. Thus, it would be worthwhile to measure the direction and extent of inequality in order to identify problems and to gauge the success of policy-making. Implications for further research are discussed.