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

Irene Garcia-Subirats, Ingrid Vargas, Amparo Susana Mogollón-Pérez, Pierre De Paepe, Maria Rejane Ferreira Da Silva, Jean Pierre Unger, Carme Borrell, Maria Luisa Vázquez

    Resultado de la investigación: Contribución a RevistaArtículo

    25 Citas (Scopus)

    Resumen

    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. © 2014 Garcia-Subirats et al.; licensee BioMed Central Ltd.
    Idioma originalEnglish (US)
    PublicaciónInternational Journal for Equity in Health
    DOI
    EstadoPublished - ene 31 2014

    Huella dactilar

    Health Services Accessibility
    Colombia
    Brazil
    Health
    Secondary Care
    Ambulatory Care
    Insurance
    Social Security
    Primary Health Care
    Patient Acceptance of Health Care
    Sampling Studies
    Continuity of Patient Care
    Emergency Medical Services
    Health Insurance
    Social Class
    Health Services
    Cross-Sectional Studies
    Delivery of Health Care

    Citar esto

    Garcia-Subirats, Irene ; Vargas, Ingrid ; Mogollón-Pérez, Amparo Susana ; De Paepe, Pierre ; Da Silva, Maria Rejane Ferreira ; Unger, Jean Pierre ; Borrell, Carme ; Vázquez, Maria Luisa. / Inequities in access to health care in different health systems: A study in municipalities of central Colombia and north-eastern Brazil. En: International Journal for Equity in Health. 2014.
    @article{4595bf967c7c45d19856c3b5356af5f0,
    title = "Inequities in access to health care in different health systems: A study in municipalities of central Colombia and north-eastern Brazil",
    abstract = "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. {\circledC} 2014 Garcia-Subirats et al.; licensee BioMed Central Ltd.",
    author = "Irene Garcia-Subirats and Ingrid Vargas and Mogoll{\'o}n-P{\'e}rez, {Amparo Susana} and {De Paepe}, Pierre and {Da Silva}, {Maria Rejane Ferreira} and Unger, {Jean Pierre} and Carme Borrell and V{\'a}zquez, {Maria Luisa}",
    year = "2014",
    month = "1",
    day = "31",
    doi = "10.1186/1475-9276-13-10",
    language = "English (US)",
    journal = "International Journal for Equity in Health",
    issn = "1475-9276",
    publisher = "BioMed Central",

    }

    Inequities in access to health care in different health systems: A study in municipalities of central Colombia and north-eastern Brazil. / Garcia-Subirats, Irene; Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Da Silva, Maria Rejane Ferreira; Unger, Jean Pierre; Borrell, Carme; Vázquez, Maria Luisa.

    En: International Journal for Equity in Health, 31.01.2014.

    Resultado de la investigación: Contribución a RevistaArtículo

    TY - JOUR

    T1 - Inequities in access to health care in different health systems: A study in municipalities of central Colombia and north-eastern Brazil

    AU - Garcia-Subirats, Irene

    AU - Vargas, Ingrid

    AU - Mogollón-Pérez, Amparo Susana

    AU - De Paepe, Pierre

    AU - Da Silva, Maria Rejane Ferreira

    AU - Unger, Jean Pierre

    AU - Borrell, Carme

    AU - Vázquez, Maria Luisa

    PY - 2014/1/31

    Y1 - 2014/1/31

    N2 - 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. © 2014 Garcia-Subirats et al.; licensee BioMed Central Ltd.

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

    U2 - 10.1186/1475-9276-13-10

    DO - 10.1186/1475-9276-13-10

    M3 - Article

    JO - International Journal for Equity in Health

    JF - International Journal for Equity in Health

    SN - 1475-9276

    ER -