Out-of-pocket expenditures on child health during an economic recession in Brazil

To investigate the association between the 2014-2016 economic recession in Brazil and households' direct expenditures on child health across the distribution of such expenditures.

Using longitudinal datasets that followed children born in Pelotas, in the state of Rio Grande do Sul, in 2004 and 2015, estimates were obtained using a Double-Hurdle model, which provides one outcome for the probability of incurring any expenditure and another for the expected value of those expenses when they occur.

The findings showed that the economic recession during this period reduced the likelihood of incurring any health-related expenditure, excluding health insurance, by 34% among 12-month-old children and by 29% among 24-month-old children. Regarding health insurance expenditures, the recession reduced the likelihood of occurrence by 37% among 12-month-olds and by a substantial 68% among 24-month-olds. As for the amount spent, given that some expenditure occurred, the economic recession was associated with an expected 15% higher total spending excluding health insurance, and a 9% lower expected spending on health insurance for 12-month-old children.

Thus, total health expenditures, excluding health insurance, were less likely to occur during the economic recession; however, when such expenditures occurred, their expected value was higher. In contrast, spending on health insurance was lower in both analyses, reinforcing its preventive nature.