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Inpatient care of the elderly in Brazil and India: assessing social inequalities

Inpatient care of the elderly in Brazil and India: assessing social inequalities
Inpatient care of the elderly in Brazil and India: assessing social inequalities
The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.
2394-2402
Channon, Andrew A.R.
5a60607c-6861-4960-a81d-504169d5880c
Viegas Andrade, Monica
0e3ba750-dd8a-486c-93d8-fae5810a4d42
Noronha, Kenya
2054b89a-96f0-4070-8597-fc5fa39f80f5
Leone, Tiziana
bad788fd-5008-4a20-ad39-282fd96e6aca
Dilip, TR
ad9c9df2-eda5-4986-a975-742abbb935d9
Channon, Andrew A.R.
5a60607c-6861-4960-a81d-504169d5880c
Viegas Andrade, Monica
0e3ba750-dd8a-486c-93d8-fae5810a4d42
Noronha, Kenya
2054b89a-96f0-4070-8597-fc5fa39f80f5
Leone, Tiziana
bad788fd-5008-4a20-ad39-282fd96e6aca
Dilip, TR
ad9c9df2-eda5-4986-a975-742abbb935d9

Channon, Andrew A.R., Viegas Andrade, Monica, Noronha, Kenya, Leone, Tiziana and Dilip, TR (2012) Inpatient care of the elderly in Brazil and India: assessing social inequalities. Social Science & Medicine, 75 (12), 2394-2402. (doi:10.1016/j.socscimed.2012.09.015). (PMID:23041128)

Record type: Article

Abstract

The rapidly growing older adult populations in Brazil and India present major challenges for health systems in these countries, especially with regard to the equitable provision of inpatient care. The objective of this study was to contrast inequalities in both the receipt of inpatient care and the length of time that care was received among adults aged over 60 in two large countries with different modes of health service delivery. Using the Brazilian National Household Survey from 2003 and the Indian National Sample Survey Organisation survey from 2004 inequalities by wealth (measured by income in Brazil and consumption in India) were assessed using concentration curves and indices. Inequalities were also examined through the use of zero-truncated negative binomial models, studying differences in receipt of care and length of stay by region, health insurance, education and reported health status. Results indicated that there was no evidence of inequality in Brazil for both receipt and length of stay by income per capita. However, in India there was a pro-rich bias in the receipt of care, although once care was received there was no difference by consumption per capita for the length of stay. In both countries the higher educated and those with health insurance were more likely to receive care, while the higher educated had longer stays in hospital in Brazil. The health system reforms that have been undertaken in Brazil could be credited as a driver for reducing healthcare inequalities amongst the elderly, while the significant differences by wealth in India shows that reform is still needed to ensure the poor have access to inpatient care. Health reforms that move towards a more public funding model of service delivery in India may reduce inequality in elderly inpatient care in the country.

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Published date: December 2012
Organisations: Social Statistics & Demography

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Local EPrints ID: 350154
URI: https://eprints.soton.ac.uk/id/eprint/350154
PURE UUID: 3c67c4c3-b658-42eb-b797-e2902f9ce43e

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Date deposited: 19 Mar 2013 14:32
Last modified: 18 Jul 2017 04:36

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