Abstract
BackgroundHealth equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems.MethodFixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks.ResultsBoth methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV.ConclusionThe dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.
Highlights
Health equity, addressed in several publications dealing with health efficiency analysis, is not translated into the operationalization of variables, mainly due to technical difficulties
Infant mortality comprehended education as essential for its reduction, in association with variables of the health production dimension, such as the health care seeking due to diarrhea in children under 5 years old, births performed by skilled personnel and the reduction in HIV incidence
An interesting point is that from the perspective of financial resources, direct disbursements carried out by the population were harmful to infant mortality, while social or private insurance proved to be beneficial
Summary
Addressed in several publications dealing with health efficiency analysis, is not translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. Addressed in several articles and publications about health efficiency analysis, does not usually remain as a relevant result in the empirical studies that propose to test it in their econometric models. Its importance is not translated into the operationalization of variables, which usually primarily reflect the material living conditions, reduced to per capita health expenditure or per capita GDP [1]. Income inequality is rarely considered as a possible determinant of health levels [2]. Others have demonstrated that its effect is indirect, with poverty and inequity being able to modify the effect of per capita GDP in achieving health outcomes [6]
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