妇女获得医疗保健方面的社会经济不平等：厄瓜多尔的卫生改革是否成功？
Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform been successful?
机构信息
Colegio Ciencias de la Salud, Universidad San Francisco de Quito, USFQ, Quito, Ecuador.
Department of Epidemiology and Global Health, Umeå University, Umea, Sweden.
出版信息
Int J Equity Health. 2020 Oct 9;19(1):178. doi: 10.1186/s12939-020-01294-1.
BACKGROUND
Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women's health care access.
METHODS
The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.
RESULTS
Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use.
CONCLUSIONS
While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.
背景
在过去的 12 年中，厄瓜多尔实施了全面的卫生部门改革，以确保根据需求公平获得医疗保健服务。尽管在医疗保健覆盖方面取得了重要成就，但这些改革对医疗保健方面的社会经济不平等的影响尚未得到分析。本研究评估了 2007 年至 2017 年实施的十年间的医疗保健改革是否有助于减少妇女获得医疗保健方面的社会经济不平等。
方法
本研究基于厄瓜多尔进行的两次生活水平衡量调查（2006 年和 2014 年）。对育龄妇女（15 至 49 岁）的数据进行了分析，以评估三个指标的医疗保健覆盖率：熟练接生、宫颈癌筛查和现代避孕药具的使用。使用二项式回归分析，为每个时间段计算了卫生保健指标和社会经济变量之间的绝对风险差异。还为每个社会经济变量和时间段计算了不平等斜率指数（SII）。纳入社会经济变量和时期的乘法交互项，以评估医疗保健方面的社会经济不平等随时间的变化。
结果
在卫生部门改革期间，在三个研究结果中，医疗保健的获得情况有所增加。在除职业类别外的所有社会经济变量中，熟练分娩的不平等程度均显著降低。宫颈癌筛查的不平等程度根据教育和职业而增加，但因财富而减少。仅观察到受教育程度较低的现代避孕措施。
结论
虽然在改革期间，熟练分娩方面的大多数社会经济不平等程度有所下降，但宫颈癌筛查或现代避孕药具使用方面的不平等程度并非如此。需要进一步研究以解决这些健康不平等的社会决定因素。
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