Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil

International Journal for Equity in Health

Maria Luisa Vázquez²  Carme Borrell⁵  Jean Pierre Unger³  Maria Rejane Ferreira da Silva¹  Pierre De Paepe³  Amparo Susana Mogollón-Pérez⁶  Ingrid Vargas²  Irene Garcia-Subirats⁴ 

[1] FIOCRUZ/PE, Brazil, Universidade de Pernambuco, Av. Agamenon Magalhães, S/N, Recife, Brazil;Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona 08022, Spain;The Prince Leopold Institute of Tropical Medicine, Nationalestraat 15, Antwerpen, Belgium;Ph. D. Programme in Biomedicine, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain;Ciber of Epidemiology and Public Health (CIBERESP), Madrid, Spain;Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Calle 14, Número 6-25, Bogotá, Colombia

关键词: Brazil;    Colombia;    Preventive health services;    Emergency care;    Secondary care;    Primary health care;    Inequities;    Access to health care;   

Others  :  804117
DOI  :  10.1186/1475-9276-13-10

 received in 2013-08-02, accepted in 2014-01-24,  发布年份 2014

【 摘 要 】

Introduction

Health system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia.

Methods

A cross-sectional study was conducted based on a survey of a multistage probability sample of people who had had at least one health problem in the prior three months (2,163 in Colombia and 2,167 in Brazil). The outcome variables were dichotomous variables on the utilization of curative and preventive services. The main independent variables were income, being the holder of a private health plan and, in Colombia, type of insurance scheme of the General System of Social Security in Health (SGSSS). For each country, the prevalence of the outcome variables was calculated overall and stratified by levels of per capita income, SGSSS insurance schemes and private health plan. Prevalence ratios were computed by means of Poisson regression models with robust variance, controlling for health care need.

Results

There are inequities in favor of individuals of a higher socioeconomic status: in Colombia, in the three different care levels (primary, outpatient secondary and emergency care) and preventive activities; and in Brazil, in the use of outpatient secondary care services and preventive activities, whilst lower-income individuals make greater use of the primary care services. In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels. Income in both countries, insurance scheme enrollment in Colombia and holding a private health plan in Brazil all contribute to the presence of inequities in utilization.

Conclusions

Twenty years after the introduction of reforms implemented to improve equity in access to health care, inequities, defined in terms of unequal use for equal need, are still present in both countries. The design of the health systems appears to determine access to the health services: two insurance schemes in Colombia with different benefits packages and a segmented system in Brazil, with a significant private component.

【 授权许可】

   
2014 Garcia-Subirats et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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