Division of Health Education, Western Oregon University, 345 N. Monmouth Ave., Monmouth, OR 97361, USA.
Health Policy Plan. 2010 May;25(3):209-18. doi: 10.1093/heapol/czp052. Epub 2009 Nov 16.
This article examines socio-economic determinants and inequality of health care utilization in Ecuador. Despite health reform efforts in Latin America, drastic socio-economic inequalities persist across the region, including Ecuador. Almost a third of Ecuador's population lack regular access to health services, while more than two-thirds have no health insurance and insufficient resources to pay for health care services. Using Andersen's model of health care utilization behaviour, relevant variables were selected from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN) household survey. Four outcomes were assessed: use of preventive services, number of curative visits, hospitalization, and use of antiparasitic medicines. Adjusting for various predisposing, enabling and need factors, a significant negative relationship was found between household economic status (as measured by assets and consumption quintiles) and utilization of preventive and curative services. The same was true for use of antiparasitic medicines. Further, indigenous ethnicity was found to be a significant negative predictor of health care utilization, regardless of economic status. These socio-economic inequalities in the use of health care services suggest the need for health care reform in Ecuador to address these issues more systematically. It is necessary for public health authorities to move forward on a reform that will expand coverage, particularly to indigenous and low- and middle-income households.
本文探讨了厄瓜多尔医疗保健利用的社会经济决定因素和不平等现象。尽管拉丁美洲进行了医疗改革，但该地区仍存在着巨大的社会经济不平等，厄瓜多尔也不例外。近三分之一的厄瓜多尔人口无法定期获得医疗服务，超过三分之二的人没有医疗保险，也没有足够的资源支付医疗保健费用。本文利用安德森的医疗保健利用行为模型，从 2004 年全国人口和母婴健康调查（ENDEMAIN）家庭调查中选择了相关变量。评估了四个结果：预防服务的使用、治疗性就诊次数、住院和驱虫药物的使用。在调整了各种倾向因素、促成因素和需求因素后，发现家庭经济状况（以资产和消费五分位数衡量）与预防和治疗性服务的利用之间存在显著的负相关关系。驱虫药物的使用也是如此。此外，无论经济状况如何，土著民族的民族身份都被发现是医疗保健利用的一个显著负预测因素。医疗保健服务利用方面的这些社会经济不平等现象表明，厄瓜多尔需要进行医疗保健改革，以更系统地解决这些问题。公共卫生当局有必要推进一项改革，扩大覆盖范围，特别是针对土著居民和中低收入家庭。
