2012年-世界发展银行全球_Health_Equity_and_Financial_Protection_Datasheets___Latin_America_42页_4mb

Health Equity and Financial Protection Summary for Latin America

Overview

This summary presents the core findings from the Health Equity and Financial Protection Datasheets for several Latin American countries, including Belize, Bolivia, Brazil, and Colombia. The reports examine health equity and financial protection through a range of indicators, including health outcomes, risky behaviors, health care utilization, and financial protection measures. Data are sourced from household surveys such as the Demographic and Health Surveys (DHS), World Health Surveys (WHS), Multiple Indicator Cluster Surveys (MICS), and Living Standards and Measurement Surveys (LSMS), and all analyses are conducted using the ADePT software.

Core Content

1. Health Equity and Financial Protection Framework

• The reports focus on inequalities in health outcomes, health behaviors, health care utilization, benefit incidence analysis, financial protection, and the progressivity of health financing.
• Concentration Index (CI) is used to measure inequality, with values ranging from -1 to 1. A negative CI indicates that health outcomes are more prevalent among the poor, while a positive CI suggests greater prevalence among the rich.
• Significance levels are indicated by ***, **, and *** for 10%, 5%, and 1% significance, respectively.

Main Findings by Country

Belize

Health Inequalities in Outcomes

• Stunting: 38.4% (Q1), 23.8% (Q2), 17.2% (Q3), 16.5% (Q4), 7.9% (Q5), Total: 22.9%, CI: -0.287*.
• Underweight: 10.2% (Q1), 5.5% (Q2), 5.0% (Q3), 2.0% (Q4), 0.7% (Q5), Total: 5.3%, CI: -0.394*.
• Diarrhea: 15.7% (Q1), 12.2% (Q2), 12.5% (Q3), 9.2% (Q4), 8.1% (Q5), Total: 12.0%, CI: -0.124.
• Acute respiratory infection (ARI): 19.5% (Q1), 16.5% (Q2), 10.4% (Q3), 13.9% (Q4), 12.9% (Q5), Total: 15.0%, CI: -0.099.

Health Inequalities in Risky Behavior

• Concurrent partnerships: 1.4% (Q1), 1.4% (Q2), 3.4% (Q3), 1.6% (Q4), 0.0% (Q5), Total: 1.6%, CI: -0.168.

Health Care Utilization Inequalities

• Contraceptive prevalence: 19.1% (Q1), 31.2% (Q2), 37.3% (Q3), 36.6% (Q4), 37.7% (Q5), Total: 33.1%, CI: 0.098*.
• HIV voluntary counseling and testing: 85.6% (Q1), 87.0% (Q2), 91.7% (Q3), 92.9% (Q4), 96.5% (Q5), Total: 91.6%, CI: 0.026*.

Bolivia

Health Inequalities in Outcomes

• Infant mortality rate: 114.6 (Q1), 88.9 (Q2), 78.7 (Q3), 38.4 (Q4), 27.7 (Q5), Total: 77.7, CI: -0.238*.
• Under-five mortality rate: 165.3 (Q1), 118.1 (Q2), 117.2 (Q3), 45.3 (Q4), 37.2 (Q5), Total: 108.0, CI: -0.253*.
• Stunting: 49.6% (Q1), 40.1% (Q2), 30.5% (Q3), 20.2% (Q4), 10.4% (Q5), Total: 33.5%, CI: -0.229*.
• Underweight: 11.2% (Q1), 6.3% (Q2), 4.3% (Q3), 2.5% (Q4), 3.1% (Q5), Total: 6.1%, CI: -0.318*.
• Diarrhea: 22.0% (Q1), 20.3% (Q2), 20.7% (Q3), 17.6% (Q4), 11.7% (Q5), Total: 19.3%, CI: -0.080*.
• Acute respiratory infection: 26.9% (Q1), 27.2% (Q2), 20.2% (Q3), 25.1% (Q4), 21.3% (Q5), Total: 24.5%, CI: -0.038*.
• Fever: 30.5% (Q1), 28.6% (Q2), 30.9% (Q3), 30.6% (Q4), 25.8% (Q5), Total: 29.6%, CI: -0.015.

Health Inequalities in Risky Behavior

• Concurrent partnerships: 4.4% (Q1), 5.3% (Q2), 6.9% (Q3), 9.6% (Q4), 14.8% (Q5), Total: 8.8%, CI: 0.251*.
• Condom usage (more than one partner): 2.1% (Q1), 9.7% (Q2), 10.5% (Q3), 22.1% (Q4), 25.3% (Q5), Total: 18.8%, CI: 0.219*.
• Smoking (women): 6.2% (Q1), 5.4% (Q2), 6.7% (Q3), 8.1% (Q4), 14.8% (Q5), Total: 8.6%, CI: 0.226*.

Health Care Utilization Inequalities

• Full immunization: 22.1% (Q1), 24.9% (Q2), 20.9% (Q3), 33.9% (Q4), 30.5% (Q5), Total: 25.6%, CI: 0.075.
• Treatment of diarrhea: 45.1% (Q1), 47.2% (Q2), 49.2% (Q3), 50.5% (Q4), 58.0% (Q5), Total: 48.4%, CI: 0.042.
• Medical treatment of ARI: 33.0% (Q1), 48.3% (Q2), 48.2% (Q3), 52.8% (Q4), 64.7% (Q5), Total: 46.2%, CI: 0.124*.
• Skilled antenatal care (4+ visits): 53.4% (Q1), 79.5% (Q2), 90.0% (Q3), 95.2% (Q4), 97.2% (Q5), Total: 78.9%, CI: 0.130*.
• Skilled birth attendance: 72.8% (Q1), 89.5% (Q2), 96.8% (Q3), 97.9% (Q4), 99.3% (Q5), Total: 88.8%, CI: 0.071*.
• Contraceptive prevalence: 59.9% (Q1), 58.0% (Q2), 55.1% (Q3), 56.6% (Q4), 54.7% (Q5), Total: 56.3%, CI: -0.010.

Brazil

Health Inequalities in Outcomes

• Infant mortality rate: 85.9 (Q1), 50.1 (Q2), 36.1 (Q3), 24.1 (Q4), 28.0 (Q5), Total: 50.1, CI: -0.261*.
• Under-five mortality rate: 106.4 (Q1), 61.1 (Q2), 44.4 (Q3), 32.8 (Q4), 47.6 (Q5), Total: 63.5, CI: -0.220*.
• Stunting: 27.0% (Q1), 11.6% (Q2), 7.4% (Q3), 4.1% (Q4), 3.6% (Q5), Total: 13.0%, CI: -0.415*.
• Underweight: 9.5% (Q1), 3.9% (Q2), 2.3% (Q3), 1.8% (Q4), 1.7% (Q5), Total: 4.6%, CI: -0.414*.
• Diarrhea: 14.1% (Q1), 9.2% (Q2), 9.5% (Q3), 8.1% (Q4), 5.7% (Q5), Total: 10.0%, CI: -0.153*.
• Acute respiratory infection: 26.3% (Q1), 27.1% (Q2), 23.4% (Q3), 21.4% (Q4), 20.9% (Q5), Total: 24.4%, CI: -0.049*.
• Fever: 30.5% (Q1), 26.9% (Q2), 25.4% (Q3), 21.8% (Q4), 21.9% (Q5), Total: 26.1%, CI: -0.072*.

Health Inequalities in Risky Behavior

• Smoking (all): 30.4% (Q1), 25.6% (Q2), 19.8% (Q3), 17.8% (Q4), 17.6% (Q5), Total: 22.2%, CI: -0.127*.
• Smoking (women): 27.4% (Q1), 21.6% (Q2), 14.2% (Q3), 16.8% (Q4), 16.7% (Q5), Total: 19.5%, CI: -0.110*.
• Insufficient intake of fruit and vegetables: 69.4% (Q1), 62.3% (Q2), 59.0% (Q3), 56.4% (Q4), 51.5% (Q5), Total: 57.6%, CI: -0.054*.
• Insufficient physical activity: 24.5% (Q1), 23.1% (Q2), 23.9% (Q3), 20.6% (Q4), 24.5% (Q5), Total: 23.3%, CI: -0.010.
• Drinking: 7.5% (Q1), 10.6% (Q2), 11.7% (Q3), 11.9% (Q4), 13.3% (Q5), Total: 11.0%, CI: 0.092*.

Health Care Utilization Inequalities

• Full immunization: 57.3% (Q1), 73.9% (Q2), 85.9% (Q3), 83.1% (Q4), 75.6% (Q5), Total: 73.1%, CI: 0.076*.
• Treatment of diarrhea: 42.6% (Q1), 47.9% (Q2), 51.6% (Q3), 37.3% (Q4), 29.3% (Q5), Total: 43.6%, CI: -0.010.
• Medical treatment of ARI: 33.0% (Q1), 48.3% (Q2), 48.2% (Q3), 52.8% (Q4), 64.7% (Q5), Total: 46.2%, CI: 0.124*.
• Skilled antenatal care (4+ visits): 53.4% (Q1), 79.5% (Q2), 90.0% (Q3), 95.2% (Q4), 97.2% (Q5), Total: 78.9%, CI: 0.130*.
• Skilled birth attendance: 72.8% (Q1), 89.5% (Q2), 96.8% (Q3), 97.9% (Q4), 99.3% (Q5), Total: 88.8%, CI: 0.071*.
• Contraceptive prevalence: 55.7% (Q1), 51.5% (Q2), 48.7% (Q3), 50.3% (Q4), 49.9% (Q5), Total: 50.5%, CI: -0.010.

Adult Preventive Care Inequalities

• TB screening: 6.5% (Q1), 6.5% (Q2), 6.8% (Q3), 8.4% (Q4), 9.3% (Q5), Total: 7.5%, CI: 0.096*.
• Cervical cancer screening: 85.3% (Q1), 86.3% (Q2), 86.1% (Q3), 87.0% (Q4), 90.0% (Q5), Total: 87.1%, CI: 0.009.
• Breast cancer screening: 23.5% (Q1), 23.9% (Q2), 50.3% (Q3), 59.5% (Q4), 75.0% (Q5), Total: 48.3%, CI: 0.243*.

Adult Curative Care Inequalities

• Inpatient or outpatient (12 months): 53.7% (Q1), 55.6% (Q2), 61.4% (Q3), 61.9% (Q4), 65.1% (Q5), Total: 59.5%, CI: 0.042*.
• Inpatient (12 months): 14.1% (Q1), 11.1% (Q2), 10.5% (Q3), 11.8% (Q4), 8.8% (Q5), Total: 11.3%, CI: -0.067*.
• Inpatient (5 years): 34.7% (Q1), 31.6% (Q2), 27.7% (Q3), 31.1% (Q4), 27.7% (Q5), Total: 30.6%, CI: -0.039*.
• Outpatient (12 months): 61.3% (Q1), 65.1% (Q2), 70.9% (Q3), 72.9% (Q4), 78.7% (Q5), Total: 70.0%, CI: 0.051*.

Financial Protection

• Catastrophic out-of-pocket spending (Threshold: 5%, 10%, 15%, 25%, 40% of total household consumption):

  • Headcount: 50.1%, 36.2%, 26.8%, 15.0%, 6.6%.
  • Concentration index (CI): 0.129***, 0.138***, 0.164***, 0.209***, 0.284***.

• Catastrophic out-of-pocket spending (Threshold: 5%, 10%, 15%, 25%, 40% of non-food consumption):

  • Headcount: 59.9%, 51.8%, 44.8%, 32.5%, 20.6%.
  • Concentration index (CI): 0.088***, 0.071***, 0.054***, 0.022, 0.005.

• Poverty lines:

  • US$1.25 per capita per day:

    • Percentage in poverty: 14.0% (consumption including OOP), 16.1% (consumption excluding OOP), Change: 2.0 pp, % change: 14.6%.
    • Average shortfall from the poverty line: $0.06 (including OOP), $0.08 (excluding OOP), Change: $0.01, % change: 16.9%.
    • Average shortfall from the poverty line, among the poor: $0.45 (including OOP), $0.46 (excluding OOP), Change: $0.01, % change: 2.1%.

  • US$2.00 per capita per day:

    • Percentage in poverty: 27.9% (including OOP), 31.9% (excluding OOP), Change: 4.0 pp, % change: 14.3%.
    • Average shortfall from the poverty line: $0.23 (including OOP), $0.26 (excluding OOP), Change: $0.03, % change: 15.4%.
    • Average shortfall from the poverty line, among the poor: $0.79 (including OOP), $0.80 (excluding OOP), Change: $0.01, % change: 0.9%.

Key Information

• Health Equity: All countries show significant health inequalities, with higher rates among the poor for most child health outcomes and lower rates for risky behaviors.
• Financial Protection: Out-of-pocket spending is a significant source of financial burden, with catastrophic spending increasing with higher thresholds.
• Progressivity of Health Financing: The concentration index (CI) indicates that health care financing is not progressive, as higher-income groups tend to have greater access to health services.
• Data Sources: Surveys such as DHS, MICS, and WHS are used to analyze health and financial data.
• Methodology: Quintile ranking is based on household consumption for most analyses, while WHS, DHS, and MICS use an asset index.

Conclusion

The datasheets highlight that health equity remains a challenge in Latin American countries, with significant disparities in health outcomes and access to care between the rich and the poor. Financial protection is also a concern, as out-of-pocket spending can lead to catastrophic health expenditures, especially for lower-income groups. These findings underscore the importance of targeted interventions to reduce health inequalities and improve financial protection for vulnerable populations.