Multiple inequity in health care: An example from Brazil

Estela Capelas Barbosa*, Richard Cookson

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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The paper develops and illustrates a new multivariate approach to analysing inequity in health care. We measure multiple inequity in health care relating to multiple equity-relevant variables – including income, gender, ethnicity, rurality, insurance status and others – and decompose the contribution of each variable to multiple inequity. Our approach encompasses the standard bivariate approach as a special case in which there is only one
equity-relevant variable, such as income. We illustrate through an application to physician visits in Brazil, using data from the Health and Health Care Supplement of the Brazilian National Household Sample Survey, comprising 391,868 individuals in the year 2008. We find that health insurance coverage and urban location both
contribute more to multiple inequity than income. We hope this approach will help researchers and analysts shed light on the comparative size and importance of the many different inequities in health care of interest to decision makers, rather than focus narrowly on income-related inequity
Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalSocial Science and Medicine
Early online date1 Mar 2019
Publication statusPublished - 1 May 2020


  • Brizil
  • Unfair inequality
  • Income-releated inequality
  • concentration curve

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