居住在巴西的委内瑞拉流离失所妇女的医疗保健服务可及性、质量和经济风险保护：一项横断面研究。

Healthcare access, quality and financial risk protection among displaced Venezuelan women living in Brazil: a cross-sectional study.

作者信息

Moreno-Serra Rodrigo, Ochoa-Moreno Ivan, Anaya-Montes Misael, Cardoso Fernandes Luis, Gomes Thaiza, Leal Maria Do Carmo, Cuadrado Cristóbal

机构信息

Centre for Health Economics, University of York, UK.

Universidad Nacional del Callao, Peru.

出版信息

Lancet Reg Health Am. 2024 Jun 29;37:100830. doi: 10.1016/j.lana.2024.100830. eCollection 2024 Sep.

DOI:10.1016/j.lana.2024.100830

PMID:39474464

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11519684/

Abstract

BACKGROUND

Millions of Venezuelans have been displaced because of deteriorating socio-economic conditions in their country. We examine key domains of universal health coverage among migrant Venezuelan women in Brazil: healthcare access, care quality and financial risk protection.

METHODS

We collected primary data on 2012 Venezuelan women aged 15-49 who migrated to Brazil between 2018 and 2021, in the cities of Boa Vista and Manaus, along with secondary data for Brazilian women. We used linear regression with entropy balance matching to estimate associations between migrant status and healthcare spending, utilisation and quality indicators.

FINDINGS

Our sample had a mean age of 29.5 years (S.D. 8.9), 64% (1286/2011) of mixed ethnicity, 29% (577/2011) white, 4% (71/2011) black, 3% (62/2011) indigenous and 1% (15/2011) other ethnicities. Compared to Brazilian women, migrant women had 9.5 percentage points (pp) (95% CI: 6 pp-13 pp; p < 0.0001) higher catastrophic health expenditure incidence. Migrants were 27 pp (95% CI: 11 pp-43 pp; p = 0.0008) more likely to receive healthcare when sought, but 37 pp (95% CI: -45 pp to -29 pp; p < 0.0001) less likely to have had a pap smear in the last three years. Migrants were as likely as non-migrants to have received pap smear results within three months (95% CI: -9 pp to 22 pp; p = 0.39) and clinically appropriate antenatal consultations (95% CI: -10 pp to 40 pp; p = 0.23).

INTERPRETATION

Migrant women in Brazil have relatively good healthcare access and quality outcomes. Yet a potential backlog of unmet sexual and reproductive healthcare needs and inadequate financial risk protection require policy attention.

FUNDING

UK Economic and Social Research Council (ES/T00441X/1).

摘要

背景

由于国内社会经济状况恶化，数百万委内瑞拉人被迫流离失所。我们研究了巴西境内委内瑞拉移民妇女在全民健康覆盖方面的关键领域：医疗服务可及性、医疗质量和经济风险保护。

方法

我们收集了2012名年龄在15至49岁之间、于2018年至2021年期间移民到巴西博阿维斯塔和马瑙斯市的委内瑞拉妇女的原始数据，以及巴西妇女的二手数据。我们使用带有熵平衡匹配的线性回归来估计移民身份与医疗支出、医疗服务利用及质量指标之间的关联。

研究结果

我们的样本平均年龄为29.5岁（标准差8.9），64%（1286/2011）为混血族裔，29%（577/2011）为白人，4%（71/2011）为黑人，3%（62/2011）为原住民，1%（15/2011）为其他族裔。与巴西妇女相比，移民妇女灾难性医疗支出发生率高9.5个百分点（95%置信区间：6个百分点至13个百分点；p<0.0001）。移民在寻求医疗服务时获得医疗服务的可能性高27个百分点（95%置信区间：11个百分点至43个百分点；p=0.0008），但在过去三年中进行巴氏涂片检查的可能性低37个百分点（95%置信区间：-45个百分点至-29个百分点；p<0.0001）。移民与非移民在三个月内收到巴氏涂片检查结果的可能性相同（95%置信区间：-9个百分点至22个百分点；p=0.39），以及获得临床适当的产前咨询的可能性相同（95%置信区间：-10个百分点至40个百分点；p=0.23）。