Background Health equity, although addressed in several publications dealing with health efficiency analysis, usually does not usually remain as a relevant result in empirical studies, due to the difficulty in its operationalization. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems.
Method Fixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequality was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks.
Results Both methods demonstrated that countries with higher inequality levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth showed inequality and per capita health expenditure in the final model. The variable linfant mortality comprehended education, in association with care seeking due to diarrhea, births attended by skilled health professionals and the reduction in the incidence of HIV.
Conclusion The dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it increases the levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequalities affect society altogether, generating mistrust and reduced social cohesion.