Colombian health care system: results on equity for five health dimensions, 2003 - 2008

Gómez, Francisco; Jaramillo, Teana Zapata; Beltrán, Liz Garavito

doi:10.1590/s1020-49892013000200005

Cited by 42 publications

(36 citation statements)

References 20 publications

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“…In a group of 18 OECD countries, the prevalence-adjusted HEI for doctor visits varied from zero in the U.K. to 0.14 in Canada and 0.20 in the U.S.; for dentist visits the HEI varied from 0.07 in Switzerland to 0.15 in the U.K. and 0.3 in Canada and the U.S. (data from 2008 and 2009) [42]. On the other hand, unadjusted HEI for doctor visits and hospitalizations were respectively 0.079 and 0.015 in Chile [43] and 0.091and 0.036 in Colombia [44] (data from 2008 and 2009). However, comparing our results with those from other countries is problematic due to the different measures of socioeconomic position used; for instance, the studies on OECD countries and Chile used household income and the study on Colombia used household expenditure.…”

Section: Discussionmentioning

confidence: 99%

Changes in health care inequity in Brazil between 2008 and 2013

Mullachery

Silver

Macinko

2016

Int J Equity Health

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BackgroundBrazil has made progress towards a more equitable distribution of health care, but gains may be threatened by economic instability resulting from the 2008 global financial crisis. This study measured predictors of health care utilization and changes in horizontal inequity between 2008 and 2013.MethodData were from two nationally representative surveys that measured a variety of sociodemographic, health behaviors and health care indicators. We used Poisson regression models to estimate adjusted prevalence ratios and the Horizontal Equity Index (HEI) standardized by health needs to measure inequity in the utilization of doctor and dentist visits, hospitalizations and reporting of a usual source of care (USC) for those 18 and older. To estimate the HEI, we ranked the population from the poorest to the richest using a wealth index. We also decomposed the HEI into its different components and assessed changes from 2008 to 2013.ResultsThe population proportion with doctor and dentist visits in the past year and a USC increased between 2008 and 2013, while hospitalizations declined. In 2013, pro-rich inequity in doctor visits increased significantly while the distribution of hospitalizations shifted from pro-rich in 2008 to neutral in 2013. Dentist visits were highly pro-rich and USC was slightly pro-rich; the distribution of dentist visits and USC did not change over time. Health need was a strong predictor of health care utilization regardless of the type of coverage (public or private). Education, wealth, and private health plans were associated with the pro-rich orientation of doctor and dentist visits. Private health plans contributed to the pro-rich orientation of all outcomes, while the Family Health Strategy contributed to the pro-poor orientation of all outcomes.ConclusionThe results of this study support the claim that Brazil’s population continued to see absolute gains in access to care despite recent economic crises. However, gains in equity have slowed and may even decline if investments are not maintained as the country enters deeper financial and political crises.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0431-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Changes in health care inequity in Brazil between 2008 and 2013

Mullachery

Silver

Macinko

2016

Int J Equity Health

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“…Este resultado era de esperar por las inequidades introducidas desde el inicio de la reforma en el diseño de los paquetes de beneficios y su financiación entre ambos regímenes de aseguramiento 29 . En contraste con otros estudios nacionales 10,22 , no se encontraron diferencias en el uso de los servicios por renta o posesión de seguro privado, lo que podría deberse al predominio de estratos socioeconómicos desfavorecidos en las áreas de estudio. En Brasil, los datos revelan que una situación económica desfavorable (rentas bajas y sin seguro privado) incrementa el uso del SUS para todos los niveles asistenciales, coincidiendo con otros estudios 7,8 .…”

Section: Discussionunclassified

Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil

et al. 2014

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“…However, cases of catastrophic spending are still present in Colombia, and it is a situation that must be counteracted because it affects the most vulnerable groups of the population, that is, households in rural areas and households with the highest levels of poverty [11, 12]. According to the 2007 National Health Survey, 22.1 % of Colombian households lived in rural areas and 49.6 % was placed in SISBEN levels 1 and 2 [13].…”

Section: Introductionmentioning

confidence: 99%

Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households

Amaya-Lara

2016

Int J Equity Health

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BackgroundOut-of-pocket expenditure to pay for health services could result in financial catastrophe. The purpose of this study was to identify the incidence and determinants of catastrophic out-of-pocket payments for healthcare in Colombia. The underlying hypotheses are that low-income and non-insured population in Colombia, and households living in isolated and high level of rurality regions, are more likely to incur catastrophic healthcare expenses.MethodsThis study used data from the Quality of Life National Survey conducted in Colombia in 2011. The presence of catastrophic healthcare spending was calculated using the methodology proposed by the World Health Organization in 2005. Households were classified as having catastrophic health spending when their out-of-pocket health payments were over 20 % of their payment capacity. All other households were classified as not having catastrophic health spending. A probit model was estimated aimed at determining what factors influence the probability of catastrophic healthcare spending.ResultsStudy findings show that 9.6 % of Colombian households had catastrophic expenditure. The incidence was higher in households in the Pacífica and Atlántica regions, extended and nuclear families, households with children or elderly adults, located in rural areas, and not insured under the healthcare system. The ratio of household members who work seems to reduce the risk of catastrophic healthcare spending, but the occurrence of any in-patient event increases it. So, there is no statistical evidence for rejecting the hypotheses under study.ConclusionsResults indicate the importance of establishing intervention mechanisms in order to improve equity in access and payment for health care, protect vulnerable groups against financial risk, and, consequently, reduce the incidence of catastrophic healthcare spending. For this, it is essential to achieve universal health coverage through standardized and improved health services packages for vulnerable age groups and implement healthcare campaigns for households in rural areas where the incidence of out-of-pocket payments is higher.

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Colombian health care system: results on equity for five health dimensions, 2003 - 2008

Cited by 42 publications

References 20 publications

Changes in health care inequity in Brazil between 2008 and 2013

Changes in health care inequity in Brazil between 2008 and 2013

Determinantes del uso de distintos niveles asistenciales en el Sistema General de Seguridad Social en Salud y Sistema Único de Salud en Colombia y Brasil

Catastrophic expenditure due to out-of-pocket health payments and its determinants in Colombian households

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