Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia

Abstract

ObjectivesIn Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article aims to understand the factors associated with access to preventative and curative health services for people with disabilities in Colombia. Additionally, it explores whether access to health services for people with disabilities changed during the COVID-19 pandemic.DesignThis is a population-based repeated cross-sectional study.SettingThis study took place in Colombia, from 2018 to 2021.Data sources and participantsNational Quality of Life Survey datasets in Colombia from 2018 to 2021, including people 5 years or older, were reviewed. People were classified into three groups: person with any disability, person with multiple disabilities and person without disabilities.Primary and secondary outcome measuresA multinomial regression model was used to calculate the probability of access to preventative services during the previous year in four categories: general practitioner (GP) and dentist, GP only, dentist only and no consultation. A logistic model for curative consultations with and without hospitalisation in people who reported having a health problem.ResultsPeople with disabilities demanded more preventative health services, except for dental services, compared with people without disabilities. Similarly, they experienced more health problems and demanded more curative services than people without disabilities, except during the year 2020, when no significant differences were found between people with and without disabilities. For people with disabilities, poverty was not associated with a lower likelihood of consultation, except for preventative dental consultations, which were significantly lower for poor people with disabilities. In addition, the subsidised insurance regimen was identified as an important variable in the utilisation of healthcare in Colombia.ConclusionPeople with disabilities in Colombia demand more health services compared with people without disabilities. Despite being in a worse condition according to various socioeconomic indicators, few factors affect their demand for healthcare services. The COVID-19 pandemic was associated with a significant reduction in the probability of access to outpatient treatment services during 2020 for people with disabilities. Longitudinal studies and comparison with other Latin American countries are recommended.