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Health equity in an unequal country: the use of medical services in Chile
INTRODUCTION: A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of acce...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2012
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544610/ https://www.ncbi.nlm.nih.gov/pubmed/23249481 http://dx.doi.org/10.1186/1475-9276-11-81 |
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author | Paraje, Guillermo Vásquez, Felipe |
author_facet | Paraje, Guillermo Vásquez, Felipe |
author_sort | Paraje, Guillermo |
collection | PubMed |
description | INTRODUCTION: A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. METHODS: Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed) and a “distribution effect” (how these indices would change with no change in average use) were obtained. RESULTS: Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. CONCLUSIONS: The increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e.g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform. |
format | Online Article Text |
id | pubmed-3544610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35446102013-01-16 Health equity in an unequal country: the use of medical services in Chile Paraje, Guillermo Vásquez, Felipe Int J Equity Health Research INTRODUCTION: A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. METHODS: Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed) and a “distribution effect” (how these indices would change with no change in average use) were obtained. RESULTS: Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. CONCLUSIONS: The increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e.g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform. BioMed Central 2012-12-18 /pmc/articles/PMC3544610/ /pubmed/23249481 http://dx.doi.org/10.1186/1475-9276-11-81 Text en Copyright ©2012 Paraje and Vasquez; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Paraje, Guillermo Vásquez, Felipe Health equity in an unequal country: the use of medical services in Chile |
title | Health equity in an unequal country: the use of medical services in Chile |
title_full | Health equity in an unequal country: the use of medical services in Chile |
title_fullStr | Health equity in an unequal country: the use of medical services in Chile |
title_full_unstemmed | Health equity in an unequal country: the use of medical services in Chile |
title_short | Health equity in an unequal country: the use of medical services in Chile |
title_sort | health equity in an unequal country: the use of medical services in chile |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544610/ https://www.ncbi.nlm.nih.gov/pubmed/23249481 http://dx.doi.org/10.1186/1475-9276-11-81 |
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