Monitoring access barriers to health services in the Americas: a mapping of household surveys

Abstract

Objective. To map the range of access barriers indicators for which data can be derived from household surveys in the Americas. Methods. A systematic mapping review study was conducted to identify access dimensions and indicators of access barriers for general health services already described in the literature; and identify whether data for those indicators could be derived from household surveys in the Americas and what was the methodology used in these surveys. Results. The study found 49 eligible surveys (287 datasets) from 31 countries in the Americas from which 23 measures of access barriers could be generated. These indicators measure self-reported access barriers for unmet healthcare needs through forgone care, as well as delayed care, unsatisfaction with care and experiences during health service provision. Multiple barriers could be identified, although there was marked heterogeneity in variables included and how barriers were measured. Conclusions. This study identified tracer indicators that countries in the Americas could use to monitor the population that experience healthcare needs but fail to seek and obtain appropriate healthcare, and what the main barriers are. The surveys identified are well validated and allow the disaggregation of these indicators by equity stratifiers. Given the variability of the methodologies used in these surveys, comparability across countries could be limited. As such, their virtue lies in helping stakeholders compare levels of access barriers over time for a given country or a group of countries. Country buy-in will directly affect the extent to which access barriers data are collected, reported, and used.

Mapping of Household Surveys to Measure Barriers to Access to Maternal and Child Health Services in India

“…This is particularly meaningful in identifying the population groups that fail to seek and obtain care and understanding the reasons why they are unable to obtain it. Our study contributes to the growing field of quantitative studies that analyse access barriers for the general population based on population surveys and have traditionally been almost non-existent outside of high-income countries (Houghton et al, 2020).…”

Content Validity of a Scale Designed to Measure the Access of Older Adults to Outpatient Health Services

“…Using the deductive method, that is, inferring from available materials which content would be suitable for the scale [ 34 ], we searched for items across three main sources, under the assumption that they possessed adequate metric properties: (1) national surveys on health and aging conducted in Mexico during 2018; these surveys have been a source of population information representative at national/regional levels and with demonstrated comparability over time in the last two decades in Mexico [ 38 , 39 ]; (2) standardized measurements of accessibility and personal abilities [ 36 , 40 , 41 ]; and (3) empirical studies on access to health services [ 35 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Based on these measures, we then classified (grouped) and selected the items consistent with our operational definitions.…”

“… Note: NS: National survey on health and aging conducted in Mexico [ 38 , 39 ]; SM: Standardized measure for a dimension of accessibility or personal abilities [ 36 , 40 , 41 ]; ES: Empirical study on access to health services [ 35 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]; IT# = Item number. …”

Barreras de acceso a los servicios de salud para mujeres, niños y niñas en América Latina

“…A su vez, existen muy pocos estudios que evalúen hasta qué punto la experiencia con estos problemas logra predecir una menor utilización de servicios de salud (10,11). De hecho, al 2021, no se han realizado estudios de este tipo para el contexto de América Latina y el Caribe (12). Por este motivo, el objetivo de este trabajo es determinar si existe una asociación entre el informe de barreras de acceso por mujeres de 15 a 49 años y la utilización de servicios esenciales de salud para ellas y sus hijos e hijas en países de América Latina.…”