Equity in health care: An urban and rural, and gender perspective; the Suriname Health Study

BACKGROUND: The literature reports that the use of healthcare services in urban areas compared to rural areas and by females compared to males is often higher. The aim of this study is to evaluate equity on geographical living area and gender for the use of primary and secondary healthcare in Suriname. METHODS: We used 5,671 records (99%) from the Suriname Health study which was designed according to World Health Organization (WHO) Steps guidelines. We evaluated the Prevalence Ratio (PR) for living area and gender in using primary (PHC) and secondary healthcare (SHC) adjusted for the perceived need for healthcare, socio-economic factors and disease factors and the effect of all factors was measured. RESULTS: Overall a percentage of 46.7 (95% Confidence Interval (CI) 45.1–48.4) had used primary healthcare and 12.7 (95% CI 11.6–13.8) secondary healthcare in the past 12 months. The PR for males compared to females was 0.75 (95% CI 0.70–0.81) for primary healthcare and 0.82 (95% CI 0.69–0.98) for secondary healthcare. The PR for urban and rural coastal areas compared to the rural interior was 1.52 (95 % CI 1.36–1.70) and 1.53 (95% CI 1.36–1.71), respectively. For the use of SHC, the PR for urban and rural coastal areas compared to the rural interior was 9.3 (95 % CI 5.44–15.89) and 8.58 (95% CI 4.98–14.81). The attributable effect of perceived healthcare-need to the PR of the urban and rural coastal areas was 39.64% and 37.81% compared to the rural interior for secondary healthcare. Further, 31.74% and 13.56% were due to socioeconomic factors. CONCLUSION: Although we observed equity between living areas for PHC use, for SHC use we observed a disadvantaged position for the rural interior, mainly influenced by socioeconomic factors. We measured gender equity for both PHC and SHC use.