Abstract
OBJECTIVE: To investigate the association between the 2014-2016 economic recession in Brazil and households' direct expenditures on child health across the distribution of such expenditures. METHODS: Using longitudinal datasets that followed children born in Pelotas, in the state of Rio Grande do Sul, in 2004 and 2015, estimates were obtained using a Double-Hurdle model, which provides one outcome for the probability of incurring any expenditure and another for the expected value of those expenses when they occur. RESULTS: The findings showed that the economic recession during this period reduced the likelihood of incurring any health-related expenditure, excluding health insurance, by 34% among 12-month-old children and by 29% among 24-month-old children. Regarding health insurance expenditures, the recession reduced the likelihood of occurrence by 37% among 12-month-olds and by a substantial 68% among 24-month-olds. As for the amount spent, given that some expenditure occurred, the economic recession was associated with an expected 15% higher total spending excluding health insurance, and a 9% lower expected spending on health insurance for 12-month-old children. CONCLUSIONS: Thus, total health expenditures, excluding health insurance, were less likely to occur during the economic recession; however, when such expenditures occurred, their expected value was higher. In contrast, spending on health insurance was lower in both analyses, reinforcing its preventive nature.