Social inequality in health and the utilization of health services among the elderly in Latin America

Objective. To learn if there is social inequality in health and in the utilization of health services among the elderly in six cities of Latin America: Buenos Aires, Argentina; Sao Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. Methods. This study used data from a project called Health, Well-being, and Aging in Latin America and the Caribbean (known as the "SABE project"). To investigate the presence of social inequality in health an ordinal probit model was used, with health living, in-status indicated by the following dependent variables: activities of daily strumental activities of daily living, physical mobility, and self-rated health. To measure social inequality in the utilization of health services two characteristics were assessed: one for outpatient medical services (whether or not individuals received outpatient care, and how many times), and one for hospital admissions (whether or not individuals were hospitalized). For outpatient services, we estimated a negative binomial hurdle model, and for hospital admissions, a logit model was constructed. Results. Our main results suggest the presence of social inequality in health in all the cities, with better-off socioeconomic groups having better health. The difference in health was less marked in Havana, Buenos Aires, and Montevideoi and it was more pronounced in Sao Paulo and Mexico City. With respect to the utilization of health services we found inequalities in the use of outpatient services in Santiago, Mexico City, and Sao Paulo. In Santiago and Mexico City, more schooling was-associated with a higher number of expected outpatient medical visits; however, the opposite was found in Sao Paulo. For hospital admissions, inequality was found only in Sao Paulo, with individuals with more years of schooling being much more likely to be hospitalized. Conclusion. To a certain extent, our results reflect the socioeconomic and demographic characteristics of the countries in which each of the six cities is located. The cities in the countries with the worst social indicators (high income inequality and low human development index) tended to have the greatest inequalities in health and in the utilization of health services.