Income and out-of-pocket health expenditure in living arrangements of families with older adults in Brazil

Abstract: The main objective of this study was to characterize household sociodemographic and economic patterns of different living arrangements of families with older adults in Brazil and their relationship with income and out-of-pocket health expenditure. Data were extracted from the 2008-2009 Brazilian Household Budget Survey (POF, in Portuguese) database of the Brazilian Institute of Geography and Statistics. Families with older adults represented 28% of all families, being smaller and having higher average income when compared to families without older adults. Older adults were head of the household in 85% of the families, with income based mainly on social protection policies. The families with older adult or couple as head of the household had significantly higher average monthly income. The proportion of out-of-pocket health expenditure per income quintile per capita was higher for families with one older adult or couple as head of the household, when compared to families without older adult as head of the household and even more in families without older adults at all. These findings allow the identification of potential positive impacts on the quality of life of families with older adults in Brazil. The higher household income of families with older adults is a consequence of the expansion of inclusive social protection policies for this population in the 2000s in Brazil, especially for families with lower average income levels, representing 4/5 of this population. The economic and political crisis in the 2010s have probably reduced these families’ relative advantage, and this study will compare with results of the next survey.

摘要：本研究的核心目标是刻画巴西老年家庭不同居住安排的社会人口学与经济特征，及其与收入和自费医疗支出的关联。研究数据取自巴西地理与统计研究所（Brazilian Institute of Geography and Statistics）2008-2009年巴西家庭预算调查（葡萄牙语缩写为POF）数据库。有老年人的家庭占全部家庭的28%，相较于无老年人的家庭，此类家庭规模更小且平均收入更高。其中85%的家庭以老年人作为户主，其收入主要来源于社会保障政策。以老年人或老年夫妇为户主的家庭，月均收入显著更高。按人均收入五分位分组的自费医疗支出占比，在以单个老年人或老年夫妇为户主的家庭中更高；相较于无老年人户主的家庭，完全无老年人的家庭该支出占比甚至更高。上述研究结果可用于识别巴西老年家庭生活质量的潜在积极影响因素。巴西2000年代针对该群体的包容性社会保障政策扩张，是老年家庭收入水平更高的成因，此类政策尤其惠及了占该群体五分之四的低收入平均水平家庭。2010年代的经济与政治危机或削弱了这类家庭的相对优势，本研究将与后续调查的结果进行对比分析。