Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Universidad San Francisco de Quito USFQ, Colegio de Ciencias de la Salud, Quito, Ecuador.
BMC Public Health. 2022 Mar 14;22(1):499. doi: 10.1186/s12889-022-12884-9.
Limited research is available about the impact of healthcare reforms on healthcare utilization according to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gap between the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007-2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization.
We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difficulties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes in inequalities over time. Sample weights were applied to all analyses, and 95% confidence intervals were calculated to assess statistical significance in the regression analysis.
In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically significant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women.
Our results showed remarkable and significant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specific indicators. Further studies are also needed to identify the main barriers that contribute to UHCN among socially disadvantaged groups.
根据社会经济群体，有关医疗改革对医疗利用影响的研究有限。尽管拉丁美洲的大多数卫生改革都侧重于缩小最有利和最不利群体之间的差距并提高卫生服务质量，但现有信息表明进展有限。因此，本研究评估了厄瓜多尔最近的医疗改革（2007-2017 年）是否有助于减少医疗利用方面的社会经济不平等。
我们使用了 2006 年和 2014 年进行的国家生活水平测量调查的数据。未满足的医疗需求（UHCN）被用作依赖变量和获取卫生服务困难的代理。居住地、种族、教育和财富被选为社会经济地位的指标。为每个时期和社会经济变量计算了成年男性和女性的斜率和相对不平等指数。在中点分数和时间之间应用乘法交互项来估计随时间变化的不平等变化。所有分析均应用样本权重，并计算回归分析的 95％置信区间以评估统计显着性。
2006 年，穷人、土著人、居住在农村地区和教育程度较低的人获得医疗服务的机会较少。2014 年，总体 UHCN 患病率从 27％降至 18％，女性高于男性。在绝对和相对方面，所有社会群体中的男性和女性都观察到拒绝治疗的比例显着降低。
我们的研究结果表明，在此期间，所有检查的社会经济群体的不平等状况都有显著且显著的下降，无论是在绝对还是相对方面。尽管建立了新的医疗保健模式以实现全民健康覆盖，但必须使用特定指标不断评估和监测其绩效。还需要进一步研究，以确定导致社会弱势群体 UHCN 的主要障碍。
