Equity of access to health care for older adults in four major Latin American cities
Revista Panamericana de Salud Pública
Objectives. To identify if older adults have equitable access to health services in four major Latin American cities and to determine if the inequities that are found follow the patterns of economic inequality in each of the four nations studied. Methods. Data from persons age 60 and over in the cities of São Paulo, Brazil (n = 2 143); Santiago, Chile (n = 1 301); Mexico City, Mexico (n = 1 247); and Montevideo, Uruguay (n = 1 450) were collected through a collaboration led by the Pan American
... y the Pan American Health Organization. For our study, three process indicators of access (availability, accessibility, and acceptability) and one indicator of actual health services use (visit to a medical doctor in the past 12 months) were analyzed by wealth quintiles, health insurance type, education, health status, and demographic characteristics. Results. Each of the four cities had a different level of access to care, and those levels of access were only weakly related to per capita national wealth. Given the relatively high level of wealth inequality in Brazil and the lower level in Uruguay, older persons in São Paulo had better-than-expected equity in access to care, while older persons in Montevideo had less equity than expected. Inequity in Mexico City was driven primarily by low levels of health insurance coverage. In Santiago, inequity followed socioeconomic status more than it did health insurance. Conclusions. In the four cities studied, health insurance and the operation of health systems mediate the link between economic inequality and inequitable access to health care. Therefore, special attention needs to be paid to equity of access in health services, independent of differences in economic inequality and national wealth. Aged; aged, 80 and over; health services for the aged; health services accessibility; socioeconomic factors; health policy; Latin America. ABSTRACT In both developed and developing nations the State plays a central role in the organization and funding of health care. State intervention fosters health care systems that tend to reflect and reinforce broader patterns of inequality (1). Political units that allow highly unequal income distributions also invest less in the health services and other services needed by the poorer segments of the population. Latin America has among the highest rates of economic inequality in the world (2). The health care systems of the na-tions of Latin America would thus be expected to reflect this economic inequality. In fact, half of the Latin American countries do fall in the bottom half of nations worldwide in equity measures of their health systems' performance (3). A focus on health care for the elderly is gaining increased governmental attention in Latin America. A number of countries, including Argentina, Keywords Investigación original / Original research Wallace SP, Gutiérrez VF. Equity of access to health care for older adults in four major Latin American cities. Rev Panam Salud Publica. 2005;17(5/6):394-409.