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Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach
BACKGROUND: Understanding health financing reforms and means is key to evaluate how maternal health has improved. Problems related to health financing policies are contributing to inadequate quality of care and inequitable use of healthcare by pregnant women, resulting in poor maternal health outcom...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393844/ https://www.ncbi.nlm.nih.gov/pubmed/32731871 http://dx.doi.org/10.1186/s12939-020-01219-y |
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author | Rivillas, Juan Carlos Devia-Rodriguez, Raúl Ingabire, Marie-Gloriose |
author_facet | Rivillas, Juan Carlos Devia-Rodriguez, Raúl Ingabire, Marie-Gloriose |
author_sort | Rivillas, Juan Carlos |
collection | PubMed |
description | BACKGROUND: Understanding health financing reforms and means is key to evaluate how maternal health has improved. Problems related to health financing policies are contributing to inadequate quality of care and inequitable use of healthcare by pregnant women, resulting in poor maternal health outcomes. The purpose of the study was to measure socioeconomic and health financing related inequality in maternal mortality in Colombia as well as identifying potential epicenters of this inequality. METHODS: The data used was obtained from National Information of Social Protection (Sispro), the Department of Planning and National Statistics Department. Maternal mortality ratios were calculated by health insurance scheme and disaggregated by health spending per capita quintiles to allow for closer examination of inequality. The Slope Index of Inequality and Concentration Index were estimated to express absolute and relative inequality. We conducted interviews with key informants involved in the implementation of health financing and maternal health policies. RESULTS: The main finding shows inequality in maternal mortality across regions and in particular in the subsidized health insurance. The contributory health insurance scheme is closing gaps over time, but inequality in the subsidized scheme is significantly widening, which impacts the severity of overall measurements of inequality. 20% of territories with the lowest health spending per capita have reached 35% of maternal mortality, and it such rates are worsening. This means that there is a marginal exclusion in which most of maternal deaths still occur in the regions with lowest resources. CONCLUSIONS: Beyond the key issues in health financing, issues of quality of care must be addressed. The country must define its own approach to financing for maternal health coverage given its unique situation and starting point. Potential policy implications that emerged are: i) afro-Colombian, indigenous, poorer and migrant women must be put at the center of the maternal health care services; ii) better skills, Reproductive, Maternal, Newborn and Child Health RMNCH training and health worker retention strategies and training in rural, insular and remote geographical areas; ii) a better understanding of provider payment mechanisms and the incentives that influence provider behaviors; and iv) inequality prompt calls for a targeted approach, whereby care is directed toward the most disadvantaged regions. |
format | Online Article Text |
id | pubmed-7393844 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-73938442020-08-04 Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach Rivillas, Juan Carlos Devia-Rodriguez, Raúl Ingabire, Marie-Gloriose Int J Equity Health Research BACKGROUND: Understanding health financing reforms and means is key to evaluate how maternal health has improved. Problems related to health financing policies are contributing to inadequate quality of care and inequitable use of healthcare by pregnant women, resulting in poor maternal health outcomes. The purpose of the study was to measure socioeconomic and health financing related inequality in maternal mortality in Colombia as well as identifying potential epicenters of this inequality. METHODS: The data used was obtained from National Information of Social Protection (Sispro), the Department of Planning and National Statistics Department. Maternal mortality ratios were calculated by health insurance scheme and disaggregated by health spending per capita quintiles to allow for closer examination of inequality. The Slope Index of Inequality and Concentration Index were estimated to express absolute and relative inequality. We conducted interviews with key informants involved in the implementation of health financing and maternal health policies. RESULTS: The main finding shows inequality in maternal mortality across regions and in particular in the subsidized health insurance. The contributory health insurance scheme is closing gaps over time, but inequality in the subsidized scheme is significantly widening, which impacts the severity of overall measurements of inequality. 20% of territories with the lowest health spending per capita have reached 35% of maternal mortality, and it such rates are worsening. This means that there is a marginal exclusion in which most of maternal deaths still occur in the regions with lowest resources. CONCLUSIONS: Beyond the key issues in health financing, issues of quality of care must be addressed. The country must define its own approach to financing for maternal health coverage given its unique situation and starting point. Potential policy implications that emerged are: i) afro-Colombian, indigenous, poorer and migrant women must be put at the center of the maternal health care services; ii) better skills, Reproductive, Maternal, Newborn and Child Health RMNCH training and health worker retention strategies and training in rural, insular and remote geographical areas; ii) a better understanding of provider payment mechanisms and the incentives that influence provider behaviors; and iv) inequality prompt calls for a targeted approach, whereby care is directed toward the most disadvantaged regions. BioMed Central 2020-07-31 /pmc/articles/PMC7393844/ /pubmed/32731871 http://dx.doi.org/10.1186/s12939-020-01219-y Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Rivillas, Juan Carlos Devia-Rodriguez, Raúl Ingabire, Marie-Gloriose Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title | Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title_full | Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title_fullStr | Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title_full_unstemmed | Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title_short | Measuring socioeconomic and health financing inequality in maternal mortality in Colombia: a mixed methods approach |
title_sort | measuring socioeconomic and health financing inequality in maternal mortality in colombia: a mixed methods approach |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393844/ https://www.ncbi.nlm.nih.gov/pubmed/32731871 http://dx.doi.org/10.1186/s12939-020-01219-y |
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