Paredes Karlo Paolo P
Department of Healthcare Management and Policy, Graduate School of Public Health, Seoul National University, Building 221, room 411, 1 Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea.
Int J Equity Health. 2016 Nov 10;15(1):181. doi: 10.1186/s12939-016-0473-y.
The Philippines failed to achieve its Millennium Development Goal (MDG) commitment to reduce maternal deaths by three quarters. This, together with the recently launched Sustainable Development Goals (SDGs), reinforces the need for the country to keep up in improving reach of maternal and child health (MCH) services. Inequitable use of health services is a risk factor for the differences in health outcomes across socio-economic groups. This study aims to explore the extent of inequities in the use of MCH services in the Philippines after pro-poor national health policy reforms.
This paper uses data from the 2008 and 2013 Demographic and Health Survey (DHS) in the Philippines. Socio-economic inequality in MCH services use was measured using the concentration index. The concentration index was also decomposed in order to examine the contribution of different factors to the inequalities in the use of MCH services.
In absolute figures, women who delivered in facilities increased from 2008 to 2013. Little change was noted for women who received complete antenatal care and caesarean births. Facility deliveries remain pro-rich although a pro-poor shift was noted. Women who received complete antenatal care services also remain concentrated to the rich. Further, there is a highly pro-rich inequality in caesarean deliveries which did not change much from 2008 to 2013. Household income remains as the most important contributor to the resulting inequalities in health services use, followed by maternal education. For complete antenatal care use and deliveries in government facilities, regional differences also showed to have important contribution.
The findings suggest inequality in the use of MCH services had limited pro-poor improvements. Household income remains to be the major driver of inequities in MCH services use in the Philippines. This is despite the recent national government-led subsidy for the health insurance of the poor. The highly pro-rich caesarean deliveries may also warrant the need for future studies to determine the prevalence of medically unindicated caesarean births among high-income women.
Not applicable.
菲律宾未能实现其千年发展目标（MDG）中关于将孕产妇死亡人数减少四分之三的承诺。这一点，再加上最近启动的可持续发展目标（SDGs），凸显了该国在提高妇幼保健（MCH）服务可及性方面持续努力的必要性。卫生服务利用的不公平是导致不同社会经济群体健康结果存在差异的一个风险因素。本研究旨在探讨菲律宾在实施扶贫国家卫生政策改革后，妇幼保健服务利用方面的不公平程度。
本文使用了菲律宾2008年和2013年人口与健康调查（DHS）的数据。妇幼保健服务利用方面的社会经济不平等采用集中指数进行衡量。为了考察不同因素对妇幼保健服务利用不平等的贡献，还对集中指数进行了分解。
从绝对数字来看，2008年至2013年期间在医疗机构分娩的妇女有所增加。接受全程产前护理和剖宫产的妇女数量变化不大。尽管出现了向扶贫方向的转变，但医疗机构分娩仍有利于富人。接受全程产前护理服务的妇女也仍然集中在富人中。此外，剖宫产存在高度有利于富人的不平等现象，2008年至2013年期间变化不大。家庭收入仍然是导致卫生服务利用不平等的最重要因素，其次是母亲的教育程度。对于全程产前护理的利用和在政府医疗机构的分娩，地区差异也显示出有重要贡献。
研究结果表明，妇幼保健服务利用方面的不平等在扶贫方面的改善有限。家庭收入仍然是菲律宾妇幼保健服务利用不平等的主要驱动因素。尽管最近国家政府为穷人的医疗保险提供了补贴，但情况依然如此。高度有利于富人的剖宫产情况可能也需要未来的研究来确定高收入妇女中无医学指征剖宫产的发生率。
不适用。
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