Horizontal Inequity in Access to Health Care in Four South American Cities

ResumenEl objetivo de este trabajo es analizar el grado de inequidad socioeconómica en el uso de servicios médicos de la población adulta mayor en cinco ciudades latinoamericanas (Buenos Aires, Ciudad de México, Santiago de Chile, San Pablo y Montevideo), en base a los datos de la Encuesta de Salud, Bienestar y Envejecimiento relevada entre 1999 y 2000 (SABE, OPS/OMS, 2001). El análisis imputa el ingreso equivalente del hogar a través de la utilización de las encuestas de hogares de los distintos países, y considerando una amplia serie de indicadores de acceso, calidad y uso de servicios de salud. Una vez estandarizado el uso de servicios por las necesidades de cuidados, se encuentran desigualdades socioeconómicas pro-rico en el uso de servicios preventivos en todas las ciudades, desigualdades en la realización de visitas médicas en Santiago y Montevideo, y desigualdades en la calidad de acceso a la atención en todas las ciudades salvo Montevideo. Las desigualdades socioeconómicas dentro de los sistemas de salud públicos o privados explican una mayor proporción de las desigualdades en el acceso a la atención. Nuestros resultados son informativos en el contexto de las políticas recientes destinadas a la aplicación de paquetes mínimos de servicios. AbstractThe objective of this paper is compare socioeconomic inequalities in the use of healthcare services in four South-American cities: Buenos Aires, Santiago, Montevideo, and San Pablo. We use secondary data from SABE, a survey on Health, Well-being and Aging administered in 2000 under the sponsorship of the Panamerican Health Organization, and representative of the elderly population in each of the analyzed cities. We construct concentration indices of access to and quality of healthcare services, and decompose them in socioeconomic, need, and non-need contributors. We assess the weight of each contributor to the overall index and compare indices across cities. Our results show high levels of pro-rich socioeconomic inequities in the use of preventive services in all cities, inequities in medical visits in Santiago and Montevideo, and inequities in quality of access to care in all cities but Montevideo. Socioeconomic inequality within private or public health systems explains a higher portion of inequalities in access to care than the fragmented nature of health systems. Our results are informative given recent policies aimed at enforcing minimum packages of services and given policies exclusively focused on defragmenting health systems.Desigualdad horizontal, acceso al sistema de salud, Suramérica.

Horizontal inequity in access to health care in four South American cities

This paper analyzes and compares socioeconomic inequalities in the use of healthcare services by the elderly in four South-American cities: Buenos Aires (Argentina), Santiago (Chile), Montevideo (Uruguay) and San Pablo (Brazil). We use data from SABE, a survey on Health, Well-being and Aging administered in several Latin American cities in 2000. After having accounted for socioeconomic inequalities in healthcare needs, we find socioeconomic inequities favoring the rich in the use of preventive services (mammograms, pap tests, breast examinations, and prostate exams) in all of the studied cities. We also find inequities in the likelihood of having a medical visit in Santiago and Montevideo, and in some measures of quality of access in Santiago, Sao Paulo, and Buenos Aires. Santiago depicts the highest inequities in medical visits and Uruguay the worse indicators in mammograms and pap scans tests. For all cities, inequities in preventive services at least double inequities in other services. We do not find evidence of a trade-off between levels of access and equity in access to healthcare services. The decomposition of healthcare inequalities suggests that inequities within each health system (public or private) are more important than between systems.inequalities, healthcare, medical visit, preventive services.

a randomized experiment with diabetic patients

Se estudian los efectos de una intervención basada en Internet en pacientes diabéticos del tipo II residentes en Montevideo. Se diseñó un sitio web y una red social virtual donde los participantes podían navegar, bajar información e interactuar con otros diabéticos así como con especialistas. No se encontró un impacto significativo del uso de estas tecnologías en el conocimiento, comportamiento o resultados de salud de los participante

The impact of ICT on adolescent's perception and consumption of substances

Considerando el potencial de las intervenciones basadas en las tecnología de la información sobre los jóvenes, se realiza una prueba controlada para conocer el impacto de estas tecnologías (Internet y SMS) en las percepciones de los adolescentes respecto al conocimiento y consumo de drogas, así como comportamientos relacionados al mismo. La población objetivo fueron estudiantes de tercero y cuarto de liceo de colegios privados de Montevide

Peer effects in risk aversion

Utilizando datos sobre adolescentes uruguayos se estima el efecto de los pares en las actitudes hacia el riesgo, en un entorno experimental sobre una muestra de estudiantes de secundari

Peer effects in the development of capabilities in adolescence

El artículo busca estudiar el impacto de los pares en el desarrollo de habilidades y capacidades en la adolescencia. Se realizó una encuesta focalizada en capacidades cognitivas, no cognitivas y relacionadas a la salud, aplicada a una muestra de adolescentes del tercer y cuarto año de secundaria, en diez colegios privados de Montevide

A Randomized Impact Evaluation of a Tuition-Free Private School Targeting Low Income Students in Uruguay

Using a randomized trial, we evaluate the impact of Liceo Jubilar, a tuition-free private school providing middle school education to poor students in Montevideo, Uruguay. The research compares adolescents randomly selected to enter the school with those not drawn in the school lottery. Several features of this school –the capacity to select personnel, a culture of high expectations, a safe and disciplined environment, differential teaching, extended instructional time, strong parental involvement, and a rich offer of extracurricular activities - contrast with the country’s highly centralized public education system. We find large positive impacts of Liceo Jubilar on students’ promotion rates and academic expectations. Our results shed light on new approaches to education that may contribute to improve opportunities for disadvantaged adolescents in developing countries

Advancing Academic Opportunities for Disadvantaged Youth: Third Year Impact Evaluation of a Privately-Managed School in a Poor Neighborhood in Montevideo

ABSTRACT. We study the three-yearimpact of a private tuition-free middle school on the academic outcomes of poor students. Several features of the treatment school fit with innovative paradigms that have deliveredsuccessful outcomes in poor urban areas. Our research design exploits the excess of applicants over the school capacity and the fact that participants were selected randomly.Specifically, we followa cohort of students that enteredmiddle school in 2010 and that were randomly assigned to attend thetreatment school or public school as usual.We find that the treatment school impactedfavorably on students’ academic advancement and math competencies. Also, the treatment school hada positive—and quite robust overtime—impact on students’ and their parents’ academicexpectations. This culture of high expectations has been previouslyidentified in the literature as a key input for school success

A Randomized Impact Evaluation of a Tuition-Free Private School Targeting Low Income Students in Uruguay

Using a randomized trial, we evaluate the impact of Liceo Jubilar, a tuition-free private school providing middle school education to poor students in Montevideo, Uruguay. The research compares adolescents randomly selected to enter the school with those not drawn in the school lottery. Several features of this school –the capacity to select personnel, a culture of high expectations, a safe and disciplined environment, differential teaching, extended instructional time, strong parental involvement, and a rich offer of extracurricular activities - contrast with the country’s highly centralized public education system. We find large positive impacts of Liceo Jubilar on students’ promotion rates and academic expectations. Our results shed light on new approaches to education that may contribute to improve opportunities for disadvantaged adolescents in developing countries

Advancing Academic Opportunities for Disadvantaged Youth: Third Year Impact Evaluation of a Privately-Managed School in a Poor Neighborhood in Montevideo

ABSTRACT. We study the three-yearimpact of a private tuition-free middle school on the academic outcomes of poor students. Several features of the treatment school fit with innovative paradigms that have deliveredsuccessful outcomes in poor urban areas. Our research design exploits the excess of applicants over the school capacity and the fact that participants were selected randomly.Specifically, we followa cohort of students that enteredmiddle school in 2010 and that were randomly assigned to attend thetreatment school or public school as usual.We find that the treatment school impactedfavorably on students’ academic advancement and math competencies. Also, the treatment school hada positive—and quite robust overtime—impact on students’ and their parents’ academicexpectations. This culture of high expectations has been previouslyidentified in the literature as a key input for school success