Characterizing changes in health care using decompositions: An integrated framework

In Latin America, the relationship between financing and equity in health sector is a key issue of public agenda. In this paper I present a comprehensive methodology to evaluate why poor people use less public services when they most need it.

First, I present a theoretical framework for health care choices, that reflect the main features of Argentina Heath Sector. I use it to show that people first choose to have or not insurance, then to use or not professional services, and finally to go or not to public facilities. Second, I show that this framework is analogous to the standard methods to estimate health care demands, know as nested logit. Both structures motivate to break down the benefit measure -people that receive the program- an indicator of objective population, population user, and public facilities user. In this way , this framework allow us to evaluate the sources of the changes in the equity of health services program, with empirical and theoretical bases.
For example, for the case of Argentina public health care facilities, we can see that between two years the equity of the program diminishes. But if we use the standard methods of benefit incidence we can not say any more. With the methods proposed in this paper we can evaluate if this changes is due, and with which intensity, to changes in insurance or use choices. In this case, we can see that when the necessity for health care increase in poor people the program fail to focalize in them despite the fact that it would suffice to reallocate resources to individuals without insurance.

Data: for this study I use two household surveys with national coverage edited by a National Program Evaluation -SIEMPRO- and carried out by standard methods by the Statistic National Institute -INDEC.