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.
Highlights
Inpatient care is a key aspect of any health system, especially with regards to the treatment of the more vulnerable older adult population
This paper explores the socioeconomic inequalities in the probability of receiving inpatient care in the last 12 months in two contrasting settings, India and Brazil, for adults aged over 60 years
There is some indication that inequalities do remain in Brazil, with differentials by education potentially indicating wealth related inequality
Summary
Inpatient care is a key aspect of any health system, especially with regards to the treatment of the more vulnerable older adult population. This paper explores the socioeconomic inequalities in the probability of receiving inpatient care in the last 12 months in two contrasting settings, India and Brazil, for adults aged over 60 years. Explored are inequalities in the length of inpatient stay for the same group of adults. The rapidly increasing older adult population in low and middle income countries provides a challenge for the provision of sufficient healthcare to this group. In many countries treatment in hospital is the main focus of healthcare for the elderly, with a heavy reliance on more expensive acute care services rather than primary or secondary prevention (World Health Organisation, 2002a). Reforming health systems in order to place prevention at the forefront of healthcare for the elderly has been acknowledged to be a major factor in reducing morbidity and expense (World Health Organisation, 2002b)
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