# **Economic Analysis of Health Care Utilization and Perceived Illness: Ethnicity and Other Factors**

_By Vicente B. Paqueo_ and _Christian Y. Gonzcilez'_

# **Introduction**

Mexico has the largest indigenous population in the Americas. Estimates of the size of the indigenous population vary, depending on its definition. But based on usage of languages other than Spanish (there are more than 60 of them), official estimates point to a population size of at least 8.4 million in 2000, which is roughly 8.6 percent of the total population. Of the 2,443 municipalities, 803 can be classified as "indigenous" in the sense that they constitute more than 30 percent of their population.<sup>2</sup> The indigenous people includes descendants from the diverse ethnic groups that made up the Aztec empire such as the Nahua, the Maya, the Zapotecs, the Mixtecs, the Totonacs and the Tarascos.

Over the years, many of Mexico's indigenous populations have managed to maintain their own language, culture and traditions. Land is central to life, culture, and history - and determines to a large extent the survival of indigenous peoples, as well as their standards of living, health and nutrition.

There has been a rising concern on the need to give greater special attention to Mexico's indigenous population. The principal reason is that they lag way behind other groups economically and socially. For example, eighty-eight percent of those indigenous municipalities have been classified as highly marginalized or very poor.<sup>3</sup> The degree of poverty is even worse for the 13,000 localities with more than 70 percent of its population speaking indigenous languages. Further, compared to the national average, the living conditions of the indigenous population are lower, as measured by per capita income, employment, health indicators, education, access to basic water, sanitation, housing, and food availability. It is remarkable that the seven states with the highest incidence of poverty - Chiapas, Oaxaca, Guerrero, Hidalgo, Veracruz, San Luis Potosi, and Puebla - coincide with the indigenous municipalities of highest marginality.<sup>4</sup> This study examines the _Encuesta Nacional de Salud 2000_ and analyzes the determinants of health service utilization and illness as assessed by the respondents. Its objective is to quantify the gap in health care utilization and understand better the nature of the gap and its causes. The analysis takes a broad view in approaching its objective. It looks at the determinants of health-seeking behavior of the general Mexican population and within this context it focuses on the effect of ethnicity. In the multivariate

> 'Opinions in this paper are those of the authors and do not reflect official positions of the World Bank. We received helpful comments from Maria Luisa Escobar and Panagiota Panopoulou, who are neverthe'less not responsible for any remaining errors. Also, we would like to thank Roberto Guzman for his assistance. 2Programa Nacional de Desaffollo de los Pueblos Indigenas, 2001-2006

> 3Programa Nacional de Desarrollo de los Pueblos Indigenas, 2001-2006

> 4World Bank (2001), Third Basic Health Care Project (PROCEDES), Project Appraisal Document

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