These South American countries are appropriate for this study due to the large racial and socio-economic variation in child and adult health insurance status (Trias and Gasparini 2004; Lopez-Cevallos and Chi 2010; Wehby et al. 2011). Higher household wealth significantly increases insurance status and explains most of the observed racial disparities in child health insurance in these countries (Wehby et al. 2011). Therefore, lack of insurance status may strongly indicate a reduced ability to pay for care in these settings.