title: Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.
abstract: OBJECTIVE
  Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS) in 2000 and 2013, before and after the reform, for the entire adult Chilean population.
  
  
  METHODS
  Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively) we estimated Erreygers concentration indices (CIs) for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex) and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement).
  
  
  RESULTS
  There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013). To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.
  
  
  CONCLUSIONS
  Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.
authors.affiliation: Faculty of Medicine Clínica Alemana, Universidad del Desarrollo, Chile, Av. La Plaza 680, Las Condes, Santiago, Chile; Department of Health Sciences, University of York, Heslington, York, England, United Kingdom.
authors.forename: Baltica
authors.initials: B
authors.lastname: Cabieses
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, England, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
authors.affiliation: Department of Public Health, Pontificia Universidad Católica de Chile, Marcoleta 340, Santiago, Chile.
authors.forename: Manuel
authors.initials: M
authors.lastname: Espinoza
authors.affiliation: Leeds Institute for Clinical Trials Research, University of Leeds, LS2 9JT, Leeds, United Kingdom.
authors.forename: Gillian
authors.initials: G
authors.lastname: Santorelli
authors.affiliation: Centro de Epidemiología y Políticas de Salud CEPS, Clínica Alemana-Faculty of Medicine,Universidad del Desarrollo, Chile, Av. La Plaza 680, Las Condes, Santiago, Chile.
authors.forename: Iris
authors.initials: I
authors.lastname: Delgado
mesh_terms: D002677:Chile; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D011203:Poverty; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires