Healthcare Accessibility Shortfalls and Hospital Infrastructures in Chile

Stefano Mainardi

doi:10.4067/S0718-88702009000200002

Authors

Stefano Mainardi UKSW - Card. S. WyszynÌski University, Warsaw

DOI:

https://doi.org/10.4067/S0718-88702009000200002

Keywords:

Healthcare services and infrastructure, stochastic frontier hurdle, inequality

Abstract

To measure healthcare accessibility, a previous study formulated a stochastic cost frontier model, and applied it to distances of communal centres from nearest emergency hospitals in Chile. Based on a larger set of variables, this study re-estimates the distance threshold, and tests alternative specifications and distribution assumptions over the period 2000-05. Complementing the analysis, ordered probit regressions help examine the cross-commune allocation of hospitals with varying complexity of medical services. Thirdly, excess distance estimates are used with other covariates in tobit models of health sector infrastructure investments. Socio-economic, demographic and geophysical conditions, along with non-hospital healthcare facilities, explain spatial inequality of hospitals. Excess distances are robust to different model specifications and distribution assumptions, and do not appear to be compensated by standards of services of the nearest hospitals or new healthcare infrastructure and upgrading investments in support to the communes concerned. Communes with perceived inadequacy in timing of medical attention turn out to often register large location inefficiency too. For the most critical communal cases, the excess distance burden amounts.

Downloads

Download data is not yet available.

References

Agostini, C., & Brown, P. (2007). Desigualdad geográfica en Chile [Geographic inequality in Chile]. Revista de Análisis Económico, 22(1), 3–33.

Agostini, C., Brown, P., & Góngora, D. P. (2008). Distribución espacial de la pobreza en Chile [Spatial distribution of poverty in Chile]. Estudios de Economía, 35(1), 79–110.

Alderman, H., & Lindert, K. (1998). The potential and limitations of self-targeted food subsidies. World Bank Research Observer, 13(2), 213–229. https://doi.org/10.1093/wbro/13.2.213

Arteaga, O., Astorga, I., & Pinto, A. M. (2002). Desigualdades en la provisión de asistencia médica en el sector público de salud en Chile [Inequalities in the provision of medical care in the public health sector in Chile]. Cadernos de Saúde Pública, 18(4), 1053–1066. https://doi.org/10.1590/s0102-311x2002000400011

Arteaga, O., Thollaug, S., Nogueira, A. C., & Darras, C. (2002a). Información para la equidad en salud en Chile [Information for health equity in Chile]. Revista Panamericana de Salud Pública, 11(5–6), 374–385. https://doi.org/10.1590/s1020-49892002000500012

Baccouche, R., & Kouki, M. (2003). Stochastic production frontier and technical inefficiency: A sensitivity analysis. Econometric Reviews, 22(1), 79–91. https://doi.org/10.1081/etc-120017975

Barrett, G., Crossley, T., & Worswick, C. (1999). Demographic trends and consumption inequality in Australia 1975–1993 (CEPR Discussion Paper No. 403). Australian National University.

Battese, G., & Coelli, T. (1995). A model for technical inefficiency effects in a stochastic frontier production function for panel data. Empirical Economics, 20(2), 325–332. https://doi.org/10.1007/bf01205442

Berger, M., & Messer, J. (2002). Public financing of health expenditures, insurance, and health outcomes. Applied Economics, 34(17), 2105–2113. https://doi.org/10.1080/00036840210135665

Bigman, D., & Deichmann, U. (2000). Spatial indicators of access and fairness for the location of public facilities. In D. Bigman & H. Fofack (Eds.), Geographical targeting for poverty alleviation: Methodology and applications (pp. 181–205). World Bank.

Bigman, D., Dercon, S., Guillaume, D., & Lambotte, M. (2000). Community targeting for poverty reduction in Burkina Faso. World Bank Economic Review, 14(1), 167–193. https://doi.org/10.1093/wber/14.1.167

Bossert, T. (2000). La descentralización de los sistemas de salud en Latinoamérica: Un análisis comparativo de Chile, Colombia y Bolivia [The decentralization of health systems in Latin America: A comparative analysis of Chile, Colombia, and Bolivia] (HSR Initiative No. 29). Harvard School of Public Health.

Brent, R. J. (1986). An axiomatic basis for the three-objective social welfare function within a poverty context. Economics Letters, 20(1), 89–94. https://doi.org/10.1016/0165-1765(86)90088-1

Brent, R. J. (1991). On the estimation technique to reveal government distributional weights. Applied Economics, 23(5), 985–992. https://doi.org/10.1080/00036849100000047

Farsi, M., Filippini, M., & Kuenzle, M. (2004). Cost efficiency in regional bus companies: An application of alternative stochastic frontier models (CEPE Working Paper No. 33). ETH Zurich.

Foster, J., Greer, J., & Thorbecke, E. (1984). A class of decomposable poverty measures. Econometrica, 52(3), 761–766. https://doi.org/10.2307/1913475

Gadikou, E., Murray, C., & Frenk, J. (2000). Measuring preferences on health system performance assessment (GPE Discussion Paper No. 20). World Health Organization.

Golan, A., Perloff, J., & Wu, X. (2001). Welfare effects of minimum wage and other government policies (CUDARE Working Paper No. 957). Department of Agricultural and Resource Economics, University of California, Berkeley.

González, C., Aguilera, X., Guerrero, A., Child-Goldenberg, V., & Georgi, H. (2000). Indicadores comunales para el estudio de la desigualdad en salud [Communal indicators for the study of health inequality]. Boletín de Vigilancia en Salud Pública de Chile, 3(11), 7–13.

Greene, W. H. (1998). LIMDEP version 7.0: User's manual. Econometric Software.

Greene, W. H. (2003b). Econometric analysis. Prentice Hall.

Hertel-Fernández, A., Giusti, A., & Sotelo, J. (2007). The Chilean infant mortality decline: Improvement for whom? Socioeconomic and geographic inequalities in infant mortality. Bulletin of the World Health Organization, 85(10), 733–820.

James, C., Carrin, G., Savedoff, W., & Hanvoravongchai, P. (2005). Clarifying efficiency-equity tradeoffs through explicit criteria, with a focus on developing countries. Health Care Analysis, 13(1), 33–51. https://doi.org/10.1007/s10728-005-2568-2

Jondrow, J., Knox Lovell, C., Materov, I., & Schmidt, P. (1982). On the estimation of technical inefficiency in the stochastic frontier production function model. Journal of Econometrics, 19(2–3), 233–238. https://doi.org/10.1016/0304-4076(82)90004-5

Kodde, D., & Palm, F. (1986). Wald criteria for jointly testing equality and inequality restrictions. Econometrica, 54(5), 1243–1248. https://doi.org/10.2307/1912331

Mainardi, S. (2003). Social welfare objectives and distribution weights in public health planning in Turkey. Journal for Studies in Economics and Econometrics, 27(3), 29–47. https://doi.org/10.1080/10800379.2003.12106351

Mainardi, S. (2007). Unequal access to public healthcare facilities: Theory and measurement revisited. Surveys in Mathematics and Its Applications, 2, 91–112.

McFadden, D. (1976). The revealed preferences of a government bureaucracy: Empirical evidence. Bell Journal of Economics, 7(1), 55–72. https://doi.org/10.2307/3003190

MIDEPLAN. (2004). Pobreza y distribución del ingreso en las regiones [Poverty and income distribution across regions] (Serie CASEN). División Social.

Ministerio de Planificación (MIDEPLAN). (2006). Encuesta CASEN 2006. División Social.

Ministerio de Salud (MINSAL) & Pontificia Universidad Católica (PUC). (2004). Resultados I Encuesta de Salud, Chile 2003. Departamento de Epidemiología.

Oliver, A., & Mossialos, E. (2004). Equity of access to health care: Outlining the foundations for action. Journal of Epidemiology and Community Health, 58(8), 655–658. https://doi.org/10.1136/jech.2003.017731

Oxoby, R., & Bischak, D. (2005). Passing the time: Other-regarding behavior and the sunk cost of time (Discussion Paper No. 2005/03). University of Calgary.

Perticara, M., & Sanhueza, C. (2008). La compleja tarea de identificar quién es pobre [The complex task of identifying who is poor]. Observatorio Económico, 14(14), 1–8. https://doi.org/10.11565/oe.vi14.304

Pizzolitto, G. (2005). Poverty and inequality in Chile: Methodological issues and a literature review. CEDLAS, Universidad Nacional de La Plata.

Ritter, C., & Simar, L. (1997). Pitfalls of Normal-Gamma stochastic frontier models. Journal of Productivity Analysis, 8(2), 167–182. https://doi.org/10.1023/a:1007751524050

Sanhueza, R., & Ruiz-Tagle, J. (2002). Choosing health insurance in a dual health care system: The Chilean case. Journal of Applied Economics, 5(1), 157–184. https://doi.org/10.1080/15140326.2002.12040574

Sapelli, C., & Torche, A. (1998). El seguro provisional de salud: Determinantes de la elección entre seguro público y privado, 1990–1994 [Provisional health insurance: Determinants of the choice between public and private insurance, 1990–1994]. Cuadernos de Economía, 35(106), 383–406.

Simson, H. (2006). Productivity in public services (CMPO Working Paper No. 07/164). University of Bristol.

Smith, P., & Street, A. (2005). Measuring the efficiency of public services: The limits of analysis. Journal of the Royal Statistical Society, 168(2), 401–417. https://doi.org/10.1111/j.1467-985x.2005.00355.x

Soto, R., & Torche, A. (2004). Spatial inequality, migration and economic growth in Chile. Cuadernos de Economía, 41(124), 401–424.

Thiede, M., & McIntyre, D. (2008). Information, communication and equitable access to health care: A conceptual note. Cadernos de Saúde Pública, 24(5), 1168–1173. https://doi.org/10.1590/s0102-311x2008000500025

Van de Walle, D. (1998). Targeting revisited. World Bank Research Observer, 13(2), 231–248. https://doi.org/10.1093/wbro/13.2.231

Verbeek, M. (2004). A guide to modern econometrics. Wiley.

Wang, H., & Schmidt, P. (2002). One-step and two-step estimation of the effects of exogenous variables on technical efficiency levels. Journal of Productivity Analysis, 18(2), 129–144. https://doi.org/10.1023/a:1016565719882

Wooldridge, J. (2002). Econometric analysis of cross-section and panel data. MIT Press.