Carlota Quintal

Equity in health care financing in Portugal: findings from the Household Budget Survey 2010/2011

Equity in health care financing is recognised as a main goal in health policy. It implies that payments should be linked to capacity to pay and that households should be protected against catastrophic health expenditure (CHE). The risk of CHE is inversely related to the share of out-of-pocket payments (OOP) in total health expenditure. In Portugal, OOP represented 26% of total health expenditure in 2010 [one of the highest among Organisation for Economic Co-operation and Development (OECD) countries]. This study aims to identify the proportion of households with CHE in Portugal and the household factors associated with this outcome. Additionally, progressivity indices are calculated for OOP and private health insurance. Data were taken from the Portuguese Household Budget Survey 2010/2011. The prevalence of CHE is 2.1%, which is high for a developed country with a universal National Health Service. The main factor associated with CHE is the presence of at least one elderly person in households (when the risk quadruples). Payments are particularly regressive for medicines. Regarding the results by regions, the Kakwani index for total OOP is larger (negative) for the Centre and lower, not significant, for the Azores. Payments for voluntary health insurance are progressive.

Aversion to geographic inequality and geographic variation in preferences in the context of healthcare

BackgroundIt is now widely accepted that social values have a role to play in terms of healthcare resource allocation decisions. Furthermore, with the recent focus on decentralization, geographic variation in preferences has become a pertinent issue. However, the geographic dimension of inequality in the distribution of health gains across different regions has received little attention in the literature.ObjectivesTo elicit the general public’s preferences regarding inequality in the distribution of health gains across regions and to test the assumption of variation in preferences across regions.MethodsA questionnaire was developed to elicit social and personal preferences. The first preference questions focused on the criteria of maximization of health gain and geographic equality of health gain. Person trade-off questions were used to assess trade-offs and inequality aversion. The latter preference questions focused on attributes of healthcare delivery. The questionnaire was administered in two Portuguese municipalities. Samples from both localities were defined by quotas based on the composition of local populations. Overall, 70 respondents (half from each municipality) self-completed the questionnaire.ResultsRespondents agreed or strongly agreed that both maximization of health gain and geographic equality of health gain should be considered in resource allocation decisions; when they were asked to make trade-offs, 70–80% were prepared to do so. Of those making trade-offs, most people were willing to forego 10–30% of total health gain to keep geographic equality of health gain in return. Regarding inequality aversion, the results indicate that there was some aversion to inequality in the sample. Regarding preference variation, the results do not corroborate the hypothesis of variation in preferences across regions.ConclusionThese results suggest that the general public supports the principles of maximization of health gain and geographic equality in the distribution of health gain. The results further suggest the existence of aversion to inequality, subject to a maximum opportunity cost. Further research is required into preference variation; in particular, in larger samples, and in other regions of Portugal.

Equidade: a chave para explicar os tarifários de água em Portugal?

Given the gap in the literature regarding equity analyses in the water industry, the objective of this paper is to evaluate whether or not income-related equity considerations are embodied in water supply tariffs, in the Portuguese municipalities. Essential minimum quantities of water are determined for representative households, which are then compared with the first tariff block’s upper limit applying on their respective municipalities. Next, representative households are ranked by costs underlying minimum quantities and by income. The methodology used in this paper is also based on concentration curves and indexes. We conclude that payments of water bills are regressive, or, in other words, there is inequity favourable to the better-off representative households.

EU health systems classification: a new proposal from EURO-HEALTHY

BackgroundIn accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems.MethodsThree methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data were mainly collected from the WHO and Eurostat databases.ResultsThe most relevant result is the proposed classification of health systems into the following clusters: Austria-Germany, Central and Northern Countries, Southern Countries, Eastern Countries ‘A’ and Eastern Countries ‘B’.ConclusionsThe proposed typology contributes to the discussion about how to classify health systems; the typology of EU health systems allows comparisons of characteristics and health system performance across clusters and policy assessment and policy recommendation within each cluster.

Socioeconomic inequalities in child obesity and overweight in Portugal

The purpose of this paper is to assess the association between socioeconomic status and child overweight/obesity in Portugal and to evaluate income-related inequalities in its distribution.,Data come from the last Portuguese National Health Survey (2005/2006) – sample of 6,903 observations. To define child overweight/obesity, the International Obesity Task Force cut-offs for body mass index (BMI) were used; the logistic regression analysis was adopted to explain the risk of overweight/obesity and inequality was measured by means of concentration curve and index.,The evidence obtained points to income-related inequalities in child overweight/obesity favourable to the better-off. The probability of child overweight/obesity was lower for higher income households, but up to a certain point a positive association between income and caloric food intake was found. The concentration index obtained was −0.072 (p-value<0.001).,Some data limitations, no information on: physical exercise; sleeping habits; parents’ education and BMI; age is coded in groups. Although the data are from 2005/2006, the current analysis is useful to future works aiming to discuss the impact of the economic and financial crisis which occurred after these data were collected.,It is important to tailor policies targeting child obesity/overweight in order to tackle not only the prevalence of this disease but also its distribution.,Drawing attention on inequalities in child obesity/overweight in Portugal as the vast majority of studies have focussed on prevalence. The middle income effect is an issue raised in this work which deserves further investigation.