The recent debate over health care reform in the United States has highlighted the impact of poverty, race and labor market position on access to health care. But what about the region? New data from the 2010 AmericasBarometer surveys, covering every country in North and South America plus many in the Caribbean, suggest that, not surprisingly, wealthier people and those more connected to the formal labor market are more likely to have health care.
The data also make clear, however, that access to health care varies widely among countries. In some, access is nearly universal; in others, it is limited to a small, privileged group. But a central factor determining the extent of health care inequality is public policy.
Historically, information on access to health care in the Americas has been spotty. International organizations, such as the UN Economic Commission on Latin America and the Caribbean and the Pan American Health Organization, publish data on the per capita ratio of doctors, nurses and hospitals, as well as on health indicators such as mortality rates and incidence of disease. But these are inadequate measures of access.
All the doctors in the world make no difference if a person lacks the means to get medical help or the ability to pay for it. And while child mortality or the incidence of disease are obviously important outcomes, the success of health care models should be measured not only by their ability to prevent these extremes, but also by the extent to which they enable access to medical practitioners for routine health issues.
The 2010 AmericasBarometer of the Latin American Public Opinion Project (LAPOP) at Vanderbilt University provides an unprecedented look at access to health care across the Americas. Face-to-face interviews with more than 40,000 residents were conducted with nationally representative samples in every country in the Americas except Cuba.1 The results are still pouring in, with responses not yet tabulated from Argentina, Chile and Haiti. (In the latter two countries, interviewing was delayed due to this year’s earthquakes.)
It is worth mentioning that these data are not evidence of coverage per se. They rely on individuals’ perceptions, memory and awareness of health care. Public coverage, in particular, is probably underreported, since in many cases citizens are covered automatically. Arguably, however, perceptions are an important component of access. You can’t use a medical plan you don’t know you have.
At present we have data from 23 countries. This article takes a first look at who in the Americas has access to health care and the kind of care they have access to. We conclude with an analysis of citizens’ attitudes toward the role of government in the provision of health care…
1. Interviews were conducted not only in English, Spanish, Portuguese, French, and Dutch, but also in several native languages. Web surveys were carried out in the U.S. and Canada. About 1,500 respondents per country were interviewed, except in Ecuador and Bolivia (around 3,000 interviews), and in Brazil (close to 2,500 interviews).
2. These questions were removed from the U.S. and Canada questionnaires due to space constraints.
3. Data for Colombia represent participation in the Plan Obligatorio de Salud, a mandatory, quasi-public program in which both private and public insurers provide coverage but the government coordinates payments and fee structures. For more information on health care in Colombia, see the Plan Obligatorio de Salud website.
4. DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith, U.S. Census Bureau, Current Population Reports, P60-236, Income, Poverty, and Health Insurance Coverage in the United States: 2008, U.S. Government Printing Office, Washington, DC, 2009.
Tags: AmericasBarometer, Health care, Latin American Public Opinion Project, Public opinion in Latin America