Quizhpe Ordóñez Edy, San Sebastian Miguel, Teran Enrique, Pulkki-Brännström Anni-Maria
Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
Colegio Ciencias de la Salud, Quito, Ecuador.
BMJ Open. 2025 Jul 30;15(7):e100522. doi: 10.1136/bmjopen-2025-100522.
Latin American countries have long struggled with socioeconomic inequalities and health equity. In 2007, Ecuador implemented a health reform to address these issues by making public health services free, coordinating finances between subsystems and increasing the state's health budget. This study evaluates whether Ecuador's health system reform (2007-2017) reduced out-of-pocket (OOP) health spending, catastrophic health spending (CHS) and socioeconomic inequalities in CHS.
Cross-sectional study.
Secondary data available of households from the 2006 and 2014 National Living Standards Measurement surveys.
Descriptive statistics (means and medians) and log-binomial regression were applied to assess prevalence of OOP and socioeconomic inequalities (residence, region, health insurance status and wealth) in catastrophic health expenditure (CHE) for each period and over time.
Overall, there was a significant reduction of 14% points in the proportion of households with OOP healthcare expenditure. The prevalence of CHE decreased from 17% to 10% and within each socioeconomic group over time. Significant reductions in relative risk were observed in all socioeconomic variables. The inequality in CHE decreased significantly in households placed in rural areas (relative difference (RD): 0.88; 95% CI: 0.79 to 0.97) and poorest (RD: 0.82; 95% CI: 0.69 to 0.97); however, it increased within regions (RD: 0.58; 95% CI: 0.44 to 0.76) and for uninsured households (RD: 1.39; 95% CI: 0.95 to 2.04).
This study suggests that recent health reform effectively reduced OOP healthcare expenditure, CHE and some socioeconomic inequalities. Future reforms should further invest in key areas, expand health insurance for the most disadvantaged and monitor progress towards universal health coverage to address persistent inequalities.
长期以来，拉丁美洲国家一直在与社会经济不平等和健康公平问题作斗争。2007年，厄瓜多尔实施了一项卫生改革，通过使公共卫生服务免费、协调子系统之间的财政以及增加国家卫生预算来解决这些问题。本研究评估了厄瓜多尔2007年至2017年的卫生系统改革是否减少了自付医疗费用、灾难性医疗支出以及灾难性医疗支出中的社会经济不平等。
横断面研究。
可获得2006年和2014年全国生活水平测量调查中家庭的二手数据。
应用描述性统计（均值和中位数）以及对数二项回归来评估每个时期及不同时间内灾难性医疗支出中自付费用和社会经济不平等（居住状况、地区、医疗保险状况和财富）的患病率。
总体而言，有自付医疗费用的家庭比例显著下降了14个百分点。随着时间推移，灾难性医疗支出的患病率从17%降至10%，且在每个社会经济群体中均如此。在所有社会经济变量中均观察到相对风险显著降低。农村地区家庭（相对差异（RD）：0.88；95%置信区间：0.79至0.97）和最贫困家庭（RD：0.82；95%置信区间：0.69至0.97）的灾难性医疗支出不平等显著下降；然而，地区内（RD：0.58；95%置信区间：0.44至0.76）以及未参保家庭（RD：1.39；95%置信区间：0.95至2.04）的不平等有所增加。
本研究表明，近期的卫生改革有效降低了自付医疗费用、灾难性医疗支出以及一些社会经济不平等。未来的改革应在关键领域进一步投资，为最弱势群体扩大医疗保险，并监测全民健康覆盖的进展情况，以解决持续存在的不平等问题。
