Socio-economic inequality in health service utilisation: Does accounting for seasonality in health-seeking behaviour matter?
Seasonal variation exists in disease incidence. The variation could occur across the different regions in a country. This paper argues that using national household data that are not adjusted for seasonal and regional variations in disease incidence may not be directly suitable for assessing socio-economic inequality in annual outpatient service utilisation, including for cross-country comparison. In fact, annual health service utilisation may be understated or overstated depending on the period of data collection. This may lead to miss-estimation of socio-economic inequality in health service utilisation depending, among other things, on how health service utilisation, across geographical areas, varies by socio-economic status. Using a nationally representative dataset from South Africa, the paper applies a seasonality index that is constructed from the District Health Information System, an administrative dataset, to annualise public outpatient health service visits. Using the concentration index, socio-economic inequality in health service visits, after accounting for seasonal variations, was compared with that when seasonal variations are ignored. It was found that, in some cases, socio-economic inequality in outpatient health service visits depends on the socio-economic distribution of the seasonality index. This may justify the need to account for seasonal and geographical variations.
['Ataguba|John E|JE|0000-0002-7746-3826']
D000553:Ambulatory Care D062306:Geography, Medical D006801:Humans D015994:Incidence D009017:Morbidity D010342:Patient Acceptance of Health Care D012621:Seasons D012959:Socioeconomic Factors D013019:South Africa
socio-economic inequality seasonal variation seasonality index concentration index