Last month (in 2011! Came around quick didn’t it?) I was fortunate to catch a plethora of super-interesting presentations at the Elsevier Social Science & Medicine conference on Health System...– check out the copious oral program alone here. Rather upsettingly, no less than 6 parallel sessions meant I didn’t catch all of them. Here’s some of the highlights from the session on inequity:

Aditi Iyer and Gita Sen of IIM Bangalore on the intersections of gender and class inequalities in healthcare access over two decades of reforms in India, using 3 rounds of household survey data:

health facilities in India: only for the guys?

• Women generally ration treatment because they perceive their illness to not be “serious”, whereas men ration treatment due to “financial barriers”, indicating that women may not perceive that their health is important. Aditi linked women understating their need due to sheer lack of time that they have to visit healthcare facilities, due to work and family demands.
• ‘Perverse (gender) catch up’ is observed in non-treatment among the poorest during the mid-1990s and 2000s, whereby the poorest men were becoming as badly off as the women due to financial barriers. This was related mainly to increases in drug prices and possibly to user charges.
• Public hospitals, usually dominated by the poor, were increasingly used by wealthier groups.
• Worrying, the squeeze on the poor was not only financial, but also in the actual availability of both public and private services.

Next up, user perceptions of China’s rural healthcare reforms from Hedda Flatoe of the Fafo Institute for Applied International Studies, Norway. Using primary collected survey data from a village in Sichuan province one year after the Wenchuan earthquake disaster, Hedda was able to do a within-case comparison of access to two different systems of distribution; first, the “normal” healthcare system on the one hand, and second, the one operating during the emergency rescue phase.

healthcare: rated better following the earthquake than during normal circumstances

• Surprisingly, Hedda found that despite the devastation caused by the earthquake,villagers perceived their opportunity to obtain healthcare services during the first months after the quake to have been the same as or better than under normal circumstances.
• The universal coverage / depth conundrum; whilst China’s rural healthcare cooperative scheme covers 90% of rural residents, only up to 40% of healthcare expenses are reimbursed by the scheme. In sample surveys, out-of-pocket payments (OPPs) exceeded over 40% of annual household income, i.e. constituted catastrophic health payments.
• In the study village, Hedda concluded that the disadvantaged continue to be less well off even under the new financing scheme.

Equity issues to ponder:

• Gender empowerment: affording women the time to visit facilities.
• Not only are privatization and user charges pushing out the poor in India, there aren’t enough health facilities full stop.
• Depth of health insurance: the utility of 90% coverage when the benefit package is shallow.

As for me, I presented a macro <haphazard> paper on income inequality and chronic disease in Asia, finding a <cross-sectional> time lagged effect of income inequality 10 – 20 years ago and chronic disease mortality in the present. Thanks to a briefly critical audience for constructive comments, esp. on disentangling a biological gestation period for NCDs from income inequality effects.