Assessing Equity in the Provision of Primary Healthcare Centers in Buenos Aires Province (Argentina): A Stochastic Frontier Analysis

Abstract

Background: Unequal access to healthcare between individuals or populations does not imply the existence of inequities as it must be controlled for differences in need. This is usually done either via direct or indirect standardization methods. Objective: We study the degree of equity in the availability of public primary healthcare centers between the 134 municipalities of the Buenos Aires province (Argentina) with a novel application of an existing statistical tool. Methods: Stochastic frontier analysis was applied to estimate the number of primary care facilities that should be available in each municipality according to demographic variables (population under age 4 years and above age 65 years), as they are the population groups with higher healthcare needs. Results: Under all specifications tried, the endowment of primary healthcare centers at the municipal level tends to increase (but less than proportionally) with the size of the population at risk. In addition, wealthier jurisdictions tend to be more equitable but also more heterogeneous. Conclusions: Stochastic frontier analysis allows us to discriminate between those districts that, according to their needs, are underserved, from those who have a surplus of health facilities. This approach can also help to explore what other elements might be responsible for the observed inequities.