Conventional wisdom and empirical data on inequalities in morbidity, use of services and health expenditures

The countries studied include: Burkina Faso, South Africa, and Zambia in Africa; Paraguay and Guatemala in Latin America; Thailand in Asia; and Kazakhstan and Kyrgyzstan in the former Soviet Union. The analyses examine the socioeconomic distribution of self-reported morbidity, health service use, and household health expenditures using existing household survey data and a common methodology. The studies measure simple deviations from equality in various aspects of the need for, use of, and spending on health services. Comparisons are made between the findings and "conventional wisdom" concerning inequalities, not across countries. Many of the results support conventional wisdom. In general, the richer and urban, compared with the poorer and rural, have a higher probability of being seen by a doctor or receiving medicines when they are ill. Richer and urban groups also spend more on drugs and, in absolute terms, more on their health care overall. In several instances, however, the findings are not in clear correspondence with conventional wisdom. In terms of self-reported illness or injury, the richer are in ill health more often than the poorer are in three of the surveyed populations. Similarly, in three countries, rural residents use hospitals more than do urban residents. There is no consistent pattern that richer households are more likely to use private providers. Richer households do not consistently devote a higher percentage of their consumption expenditures to health care than do poorer households. The analyses indicate that using conventional wisdom could result in misguided policy decision. It would appear to be worthwhile to measure the direction and extent of inequality to inform policymaking. (Author abstract, modified)