Income-related health inequality in Portugal

The Portuguese health care system is based on principles of equity and efficiency. Despite that, it appears that equality has not been fully realized owing to differences in access [Dixon and Massialos (2000)] or self-assessed health [Van Doorslaer and Koolman (2004)]. The purpose of this study is to evaluate the degree of incomerelated inequality in self-reported health in Portugal using different database and methods than those used by Van Doorslaer and Koolman (2004). This study applies the methods developed by Wagstaff and Van Doorslaer (1994) to measure the degree of income-related inequality in self-reported health by means of concentration indices. The results show that significant inequalities in self-reported ill-health exist and favour groups with higher income. Nonetheless, when compared with a similar study [Van Doorslaer et al. (1997)], the estimates for income related inequality suggest that Portugal in 1998/1999 ranks in the middle of the European countries. The most important contributors to health inequality are income, activity status and education. Regional differences, by contrast, do not exert any systematic influence. Reductions in pro-rich health inequality can be achieved by reducing the effect of income on health or reducing income inequality, or both.Fundação para a Ciência e a Tecnologia (FCT

Maternal smoking during pregnancy and birthweight : a propensity score matching approach

There is accumulated evidence of the existence of a deleterious effect of smoking on birth outcomes. Whether there is a causal link or a mere statistical association is not clear. Understanding the effect of smoking on pregnancy is a critical issue because of the public policy implications for dissuading maternal smoking. This study was designed to distinguish causal links from statistical association in the relationship between fetal exposure to maternal smoking and birth outcomes. Although the task involves several aspects of estimation we restrict our focus to the issue of self-selection. We explore this issue by using the propensity score method and compare that with parametric estimators. First we estimate the treatment effect of smoking during pregnancy on different birth outcomes. Then, we extend the method to the case of the multi-treatment “intensity of smoking”. The deleterious effect of smoking is found robust to the different estimation methods used.Fundação para a Ciência e a Tecnologia (FCT

Forum: rationing health care services. Postscript

[Excerto] O tema deste fórum é a problemática da escassez de recursos e a necessidade de racionar e priorizar os cuidados de saúde. O problema de racionamento e de priorização dos recursos não é exclusivo do setor da saúde. Virtualmente o problema põe-se em todos os setores. O que torna o debate mais apaixonante e dramático na saúde é o “carácter especial” do bem saúde, para a qualidade de vida dos indivíduos e para a promoção da igualdade de oportunidades na sociedade. O debate sobre o racionamento explícito dos cuidados de saúde está na agenda política de todos os países desenvolvidos, apesar do debate “na rua” aparecer apenas esporadicamente em situações como encerramento de serviços, adoção de novos fármacos, ou casos mediatizados de negação de cuidado de saúde. [...

Socioeconomic related inequalities in students' mathematics achievement in the European Union

This paper examines the degree of socioeconomic related inequalities in mathematics achievement for students from the European Union and presents some possible sources for the exhibited differences between countries. We applied a methodology which has been used in health economics literature namely by Wagstaff et al. (1991) and Kakwani et al. (1997). We selected parental highest level of education as a proxy for students’ socioeconomic background. Results confirm a significant inequality in achievement favouring the higher socioeconomic groups in all countries. Germany has the greatest socioeconomic related mathematics achievement inequality, followed by Greece, Great Britain and Portugal. Sweden, by contrast, is the country where the socioeconomic related inequality in PISA maths scores seems to be lower. The paper also decomposes the inequality index into the contributions of some socioeconomic factors. Socioeconomic inequality has a sizeable contribution for socioeconomic related inequality in mathematic achievement in very country. Cross-country comparison shows that in some countries, such as Belgium, Denmark or Great Britain, the impact of socioeconomic background on students’ achievement appears to be more important to determine the “excess” of socioeconomic related inequality in mathematics achievement than the inequality in the distribution of the socioeconomic variable. In other group of countries, that includes Italy, Luxembourg, Portugal and Spain, it is the inequality in the distribution of the socioeconomic variable itself that mainly explains the “excess” of socioeconomic related inequality in mathematics achievement. Portugal is a striking case exhibiting poor mathematic score, a high level of socioeconomic inequality and a high level of socioeconomic related inequality in students’ performance. Moreover, the inequality in family books possession is also a strong predictor for inequality in students’ math achievement.Fundação para a Ciência e a Tecnologia (FCT

Determinants of export diversification and sophistication in Sub-Saharan Africa

This paper studies the political and economic factors that determine successful export diversification (ED) and export sophistication (ES) strategies in the Sub-Saharan African (SSA) countries and also the way in which successful ED and sophistication strategies contribute to explain the improving in some of the millennium development goals (MDG). We run separate regressions for the determinants of ES and ED, using disaggregated data of the 48 SSA countries, from 1960 to 2005. The results suggest that better governance is an important determinant for the success of diversification and sophistication strategies in SSA. In particular the level of corruption, transparency and accountability are important factors in limiting or promoting the scope of diversification and the level of sophistication of the exports. The results also suggest that increases in human capital in SSA countries promote both ED and ES, showing that the level of education of the workforce is positively related with ES and ED, with higher levels of education (tertiary) playing a more important role in explaining ES, while lower levels of education (primary) being more important as determinants of ED. In the second part we explore the links between ED and ES and growth presenting evidence that ED and ES are linked to growth stability in SSA. This study also suggests that the Sub-Saharan countries that were more successful in achieving ED and ES tend to be more successful in improving the living conditions of their population. Using different variables of Infant Mortality (one of the MDG) and life expectancy as dependent variables, we present evidence that suggests that in SSA higher ED and ES are associated with lower infant mortality and higher life expectancy. We show that this result is robust, presenting positive and significant results even when a large number of different control variables are introduced, or when fixed effects and instrumental variables are considered. The evidence suggests that ED and ES are part of the solution for a successful development of SSA.NBER and the Center for Globalization and Governance at FEUN

Who and how should participate in health care priority setting? evidence from a Portuguese survey

This article provides highlights of the evolution of the health care rationing debate towards a more transparent and open approach involving public participation. Discretionary models that have dominated health sector decision-making are being questioned by different sectors of society. Using data from 442 college students, we explore public’s views on its involvement in health care rationing decisions. Findings suggest that although citizens wish to be consulted, they believe doctors should play the most important role on the rationing decisions. Nonetheless, the confidence in doctors is not independent of the criteria used to support their decisions.This research was partially funded by Fundação para a Ciência e a Tecnologia (FCT) through the Applied Microeconomics Research Unit (NIMA) award no. PEst-OE/EGE/UI3181/201

Alcohol attributable fractions and costs in Portugal

Aim: This study estimates alcohol attributable fractions which are used to obtain a measure of health expenditures related to alcohol misuse in Portugal. Methods and Sources: Studies estimating alcohol-attributable expenditures focus usually on specific diseases or conditions. This study takes a broader approach by examining all expenditures considered as being attributable to excessive drinking, i. e., those resulting from utilization directly and indirectly related to alcohol associated diseases. Unlike studies using the relative risk methodology, where population alcoholattributable fractions (or etiologic fractions) are based on epidemiological studies identifying potential causes of death and disease associated with alcohol excessive consumption, this study has adopted the microeconometric methodology which gets estimates of attributable fractions running econometric regressions of the annual costs of medical care (medical appointments or hospital admissions) for individuals. It has an advantage over the risk approach in that it allows to control for the effect of factors other than alcohol consumption on medical care expenditures. Actually, it includes in the analysis those factors that are linked to health care expenditures but are not linked to any particular alcohol related disease. To perform our analysis we have used two data sets provided by the Portuguese Ministry of Health: the 1995 National Health Survey. These surveys provide detailed information on individual demographic, economic, health utilization, health attributes and also alcohol and smoking use. Both surveys use a probabilistic representative sample of the non-institutionalized Portuguese population and a questionnaire of about 180 questions. It is a representative sample of the five main administrative regions of Portugal (North, Centre, Lisbon and Tejo valley, Alentejo and Algarve).Fundação para a Ciência e a Tecnologia (FCT) - POCI/EGE/55490/200

Smoking attributable health care expenditures in Portugal

Fundação para a Ciência e a Tecnologia (FCT

Environmental tobacco smoke risk perception and smoking behavior in Portugal

This study analyzes public attitudes towards environmental tobacco smoking (ETS) risks. ETS legislation and smoking behaviors using recent data from Special Eurobarometer 272 that is a unique database on public perception of ETS. Some major conclusions are drawn: (1) both smokers and non-smokers are aware of health consequences from ETS, (2) moderate and heavy smokers tend to be less concerned with seriousness of the health consequences, (3) that the belief that ETS increases the risk of a serious disease decreases the probability of being smoker, (4)ETS beliefs do not affect the quitting decision, (5) those who smoke at home appear to be aware of health consequences of ETS, (6) ETS health risk beliefs is negatively associated with the number of cigarette consumed.Fundação para a Ciência e a Tecnologia (FCT