Public versus private treatment of chronic diseases in seniors: Argentina, Brazil, Chile and Uruguay

Abstract

This article measures differences in the likelihood of treatment of chronic diseases in elders across types of coverage (private, public and social security) in four major Latin American cities: Buenos Aires (Argentina), Sao Paulo (Brazil), Santiago (Chile) and Montevideo (Uruguay). We used a logistic regression to estimate the odds ratio for treatment of chronic diseases carried by individuals with public, private and social security coverage. The data were from the Survey on health, well-being and aging in Latin America and the Caribbean (SABE) conducted in 1999 and 2000. We find a strong association between possession of public coverage only and treatment failure of chronic diseases in elders in Argentina. We find no significant association for Brazil, Chile and Uruguay. In Buenos Aires, access to private or social security coverage is a necessity for elders because the public sector fails to provide proper treatment. In the remaining cities, private or social security coverage provides similar coverage for chronic diseases in elders compared with the public sector. For this group of countries, the main difference between the former and the latter seems to be in terms of ‘luxurious’ characteristics, such as the quality of the facilities and waiting times.

Keywords:

• public healthcare
• health services accessibility
• health services for the elders
• Southern Cone Countries

Acknowledgements

The views and opinions expressed in this article are those of the author and do not necessarily represent the position of ICF International or any governmental agency.

Notes

1. For a detailed discussion of PAMI, see Lloyd-Sherlock (1997).

2. The numbers represent 1997 estimates obtained from Lobato (2000).

3. The summary statistics in Table 2 corresponds to the sample used to estimate the regression. In this sample, each record represents a reported disease, not an individual. Note that each individual may report more than one disease.

4. This note provides the definition of ‘private’, ‘social’ and ‘public’ healthcare used to construct the variables in this study. In Brazil, individuals classified with private insurance are those who answered ‘private insurance (seguro privado)’ or ‘private plan (plano privado)’. There are no individuals classified with social insurance in the survey. Individuals classified with public insurance answered ‘seguro social’ and ‘outro seguro publico’.

In Chile, individuals classified with private insurance answered ‘ISAPR y/o seguro’. Individuals classified with social insurance answered ‘FONASA’ or ‘Fuerzas Armadas’. Individuals classified with public insurance answered ‘no insurance (ninguno)’.

In Uruguay, individuals with private insurance answered ‘otro seguro privado’. Individuals with social insurance answered ‘mutualista (en forma privada)’ or ‘mutualista (a traves de DISSE)’. Individuals with public insurance answered ‘ninguno’, ‘solo sistema de emergencia’ or ‘solo sistema de acompanamiento’.

In Argentina, individuals classified with private insurance answered ‘seguro privado’. Individuals with social insurance answered ‘seguro social’. Individuals with public insurance answered ‘no insurance (no insurance)’ or ‘other public insurance (otro seguro publico)’.

5. Equivalently, a patient who is not concerned with his health is unlikely to see a reason to seek or accept treatment.

6. The deteriorating effects are evident in 2002 and 2003 in indicators such as general government expenditure per capita in US$ (see WHO data).

7. For a broader discussion of the relationship between ageing and health expenditures, see Getzen (2002).

8. This is known as the ‘moral hazard’ problem in the health economics literature; see Zweifel and Manning (2000).