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

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dc.creatorGarcia-Subirats, Irene
dc.creatorVargas, Ingrid
dc.creatorMogollón Pérez, Amparo Susana
dc.creatorDe Paepe, Pierre
dc.creatorFerreira da Silva, Maria Rejane
dc.creatorPierre Unger, Jean
dc.creatorBorrell, Carme
dc.creatorVázquez, Maria Luisa
dc.creator.googleGarcia-Subirats, Irenespa
dc.creator.googleVargas, Ingridspa
dc.creator.googleMogollón-Pérez, Amparo Susanaspa
dc.creator.googleDe Paepe, Pierrespa
dc.creator.googleDa Silva, Maria Rejane Ferreiraspa
dc.creator.googleUnger, Jean Pierrespa
dc.creator.googleBorrell, Carmespa
dc.creator.googleVázquez, Maria Luisaspa
dc.date.accessioned2020-04-23T22:01:13Z
dc.date.available2020-04-23T22:01:13Z
dc.date.created2014
dc.date.issued2014
dc.description.abstractIntroduction. 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.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1186/1475-9276-13-10
dc.identifier.issn1475-9276
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/21756
dc.language.isoengspa
dc.relation.citationIssueNo. 1
dc.relation.citationTitleInternational Journal for Equity in Health
dc.relation.citationVolumeVol. 13
dc.relation.ispartofInternational Journal for Equity in Health, ISSN: 1475-9276 Vol. 13, No. 1 (2014)spa
dc.relation.urihttps://equityhealthj.biomedcentral.com/track/pdf/10.1186/1475-9276-13-10spa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectAdolescentspa
dc.subjectHealthspa
dc.subjectAgedspa
dc.subjectBrazilspa
dc.subjectChildspa
dc.subjectChildspa
dc.subjectColombiaspa
dc.subjectCross-Sectional Studiesspa
dc.subjectHealth Servicesspa
dc.subjectHealth Services Accessibilityspa
dc.subjectHealthcare Disparitiesspa
dc.subjectIncomespa
dc.subjectInfantspa
dc.subjectInsurancespa
dc.subjectMalespa
dc.subjectRegression Analysisspa
dc.subjectYoung Adultspa
dc.subject.ddcPromoción de saludspa
dc.subject.keywordAdultspa
dc.subject.keywordFemalespa
dc.subject.keywordHumansspa
dc.subject.keywordMiddle Agedspa
dc.titleInequities in access to health care in different health systems: A study in municipalities of central Colombia and north-eastern Brazilspa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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