Puentes-Markides C
Pan American Health Organization, Health Policies Development Programme, Washington, DC 20037.
Soc Sci Med. 1992 Aug;35(4):619-26. doi: 10.1016/0277-9536(92)90356-u.
This paper is concerned with access to health care for women in developing countries, with specific reference to Latin American and Caribbean countries. It reviews the available literature on the concept of access as it relates to other variables such as accountability, affordability and acceptability of health services, taking into consideration the effects of the generalized socio-economic crisis that has affected most countries during the last decade, as well as equity objectives. Various approaches to defining variables affecting access to health care appear in the literature reviewed. While some of them indicate that ability to pay for services act as a major determinant of access to health care, others point to behavioral issues related to motivation, health seeking behavior or perception of illness as a deterrent to women in the low socioeconomic strata, while others indicate that sociocultural issues, such as values, education, religion or demographic variables related to age, influence access to health care. The paper concludes with some comments on policies and strategies for securing access to health and healthcare, indicating the need to move away from traditional solutions including framing gender-based health differences in status and access adequately, promoting and strengthening social participation of women in policy making.
本文关注发展中国家妇女获得医疗保健服务的情况，特别提及拉丁美洲和加勒比地区国家。它回顾了与医疗服务的问责制、可承受性和可接受性等其他变量相关的、有关“获得”概念的现有文献，同时考虑到过去十年影响大多数国家的普遍社会经济危机的影响以及公平目标。在所审查的文献中出现了各种界定影响获得医疗保健服务的变量的方法。其中一些表明，支付服务费用的能力是获得医疗保健服务的主要决定因素，另一些则指出与动机、就医行为或对疾病的认知相关的行为问题是社会经济地位较低阶层妇女获得医疗保健服务的障碍，还有一些表明社会文化问题，如价值观、教育、宗教或与年龄相关的人口统计学变量，会影响获得医疗保健服务的情况。本文最后对确保获得健康和医疗保健服务的政策和战略提出了一些意见，指出需要摒弃传统解决方案，包括充分界定基于性别的健康状况和获得医疗保健服务机会方面的差异，促进和加强妇女在政策制定中的社会参与。
