Inequality in financial risk protection in health among displaced populations: The case of Venezuelan women in Brazil

Abstract

Objective

Worsening economic and social conditions in Venezuela have forced many to migrate. Women and girls are particularly at risk of health vulnerability in this context. This study examines healthcare expenditure and financial risk protection inequalities among Venezuelan migrant women in Brazil.

Methods

We conducted a survey of 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021. We estimated and decomposed concentration indices to analyse inequalities in out-of-pocket healthcare expenditures (OOPHE) and catastrophic health expenditures (CHE) across the entire socioeconomic distribution. We applied Blinder-Oaxaca decompositions to explain differences in healthcare spending between migrant and Brazilian women.

Results

Venezuelan migrant women displayed noticeable disparities in OOPHE and incidence of CHE. Approximately half of our sample of migrants reported no income, no expenditures, and hence no CHE. OOPHE and CHE incidence were concentrated among less poor migrant women, whilst for Brazilian women, CHE was concentrated among the poorer. Location, time since arrival to Brazil, higher education, and income were key contributors to socioeconomic inequality in OOPHE and CHE for migrants. The main explanatory factor for differences in OOPHE between migrants and non-migrants was differences in income profiles.

Conclusions

Addressing financial risk protection in health is crucial for displaced populations, especially women and girls. While the public health system in Brazil offers universal healthcare coverage in principle, our results suggest that there is still a significant risk of lack of access to healthcare for Venezuelan migrant women, which may be driven by insufficient financial means.