Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries

Houghton, Natalia; Báscolo, Ernesto; Riego, Amalia del

doi:10.26633/rpsp.2020.11

Cited by 25 publications

(36 citation statements)

References 23 publications

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“…A previous cross-sectional study based on household surveys in 8 LAC countries showed that one-third of people, on average, reported experiencing one or more barriers to seeking appropriate care (ranging from 5% to 66% across countries) ( 18 ). Reporting of disparities across measures of inequalities in Colombia, El Salvador, Paraguay, and Peru showed that the percentage of individuals that report forgoing appropriate care was consistently higher among the poorest income quintiles in all four countries ( 19 ). Another study adapting the Commonwealth Fund International Health Policy Survey to 6 LAC countries showed that around one-third of respondents experienced multiple barriers accessing primary care, associated with cost, scheduling appointments, and long waiting times ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Following a similar approach, the global PHC Performance Initiative (PHCPI) tool reports on indicators that measure whether the population has effective, affordable, timely access to PHC facilities that are geographically convenient (17). There are a couple of cross-sectional studies based on existing household surveys that examined progress in trends and inequalities in access barriers in Colombia, El Salvador, Paraguay, and Peru (18,19). A more recent regional study identified 23 access barriers indicators that can be derived from 49 household surveys from 31 countries of the Americas (20).…”

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confidence: 99%

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Leveraging household survey data to measure barriers to health services access in the Americas

Báscolo

Houghton

Riego

2020

Revista Panamericana De Salud Pública

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Objective. To identify advantages and challenges of using household survey data to measure access barriers to health services in the Americas and to report findings from most recent surveys. Methods. Descriptive cross-sectional study using data retrieved from publicly available nationally representative household surveys carried out in 27 countries of the Americas. Values for indicators of access barriers for forgone care were generated using available datasets and reports from the countries. Results were disaggregated by wealth quintiles according to income or asset-based wealth levels. Results. Most surveys were similar in general approach and in the categories of their content. However, country-specific questionnaires varied by country, which hindered cross-country comparisons. On average, about one-third of people experienced multiple barriers to forgone appropriate care. There was great variability between countries in the experience of these barriers, although disparities were relatively consistent across countries. People in the poorest wealth quintile were more likely to experience barriers related to acceptability issues, financial and geographic access, and availability of resources. Conclusions. The analysis indicates major inequalities by wealth status and uneven progress in multiple access barriers that hinder progress towards the goals of equity as part of the Sustainable Development Goals and universal health in the Americas. Access barriers were multiple, which highlights the need for integrated and multisectoral approaches to tackle them. Given the variability between instruments across countries, future efforts are needed to standardize questionnaires and improve data quality and availability for regional monitoring of access barriers.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Leveraging household survey data to measure barriers to health services access in the Americas

Báscolo

Houghton

Riego

2020

Revista Panamericana De Salud Pública

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“…Attainment of glycemic control was associated with higher socioeconomic status (SES) [160], having health insurance [160], and better access and services [208]. Not attaining glycemic control was associated with longer duration of diabetes [163,187,209], taking insulin (alone or in combination with oral antihyperglycemic medications) [176], forgetfulness (e.g., taking multiple medication for more than one condition) [185], complex therapeutic regimes [209], inadequate access to health care services [22], and availability or health insurance coverage of medications [187], among other factors.…”

Section: Treatment and Control Of Diabetes Blood Pressure And Ldl-cmentioning

confidence: 99%

“…Far from being a monolithic group, the LatAm population is highly heterogeneous, with various populations reflecting diverse genetic ancestry, ethnicity, culture of origin, sociopolitical contexts, environmental exposures, and beliefs and practices [17,18]. Levels of inequality in LatAm remain among the highest in the world [19][20][21][22]. All these factorscoupled with biological susceptibility, income, education, access health care, cultural influences on nutrition, health, selfimage, and self-care-influence the development of diabetes in LatAm.…”

Section: Introductionmentioning

confidence: 99%

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

et al. 2020

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Purpose of Review Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. Recent Findings The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. Summary The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region. Keywords Latin America. Diabetes prevalence. Diabetes treatment. Control. Diabetes complications. Interventions. Health care This article is part of the Topical Collection on Diabetes Epidemiology

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“…Moreover, quantitative analysis of access barriers based on population surveys are almost nonexistent for the region of the Americas ( 12 ) with most examples coming from Canada, Brazil and the United States ( 10 - 12 ). There is one multicounty study assessing self-reported access barriers to primary care in six Latin American and Caribbean (LAC) countries ( 13 ), and a couple of cross-sectional studies based on available national surveys that examined progress in trends and inequalities in access barriers in eight LAC countries ( 14 , 15 ).…”

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

Houghton

Báscolo

Riego

2020

Revista Panamericana De Salud Pública

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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.

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Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries

Cited by 25 publications

References 23 publications

Leveraging household survey data to measure barriers to health services access in the Americas

Leveraging household survey data to measure barriers to health services access in the Americas

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

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

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