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Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?

BACKGROUND: Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequaliti...

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Autores principales: Quizhpe, Edy, Sebastian, Miguel San, Teran, Enrique, Pulkki-Brännström, Anni-Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545545/
https://www.ncbi.nlm.nih.gov/pubmed/33036631
http://dx.doi.org/10.1186/s12939-020-01294-1
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author Quizhpe, Edy
Sebastian, Miguel San
Teran, Enrique
Pulkki-Brännström, Anni-Maria
author_facet Quizhpe, Edy
Sebastian, Miguel San
Teran, Enrique
Pulkki-Brännström, Anni-Maria
author_sort Quizhpe, Edy
collection PubMed
description BACKGROUND: Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access. METHODS: The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time. RESULTS: Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use. CONCLUSIONS: While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.
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spelling pubmed-75455452020-10-13 Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful? Quizhpe, Edy Sebastian, Miguel San Teran, Enrique Pulkki-Brännström, Anni-Maria Int J Equity Health Research BACKGROUND: Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access. METHODS: The present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across three indicators: skilled birth attendance, cervical cancer screening, and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time. RESULTS: Access to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a poorer education was observed for modern contraceptive use. CONCLUSIONS: While most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities. BioMed Central 2020-10-09 /pmc/articles/PMC7545545/ /pubmed/33036631 http://dx.doi.org/10.1186/s12939-020-01294-1 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
Quizhpe, Edy
Sebastian, Miguel San
Teran, Enrique
Pulkki-Brännström, Anni-Maria
Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title_full Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title_fullStr Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title_full_unstemmed Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title_short Socioeconomic inequalities in women’s access to health care: has Ecuadorian health reform been successful?
title_sort socioeconomic inequalities in women’s access to health care: has ecuadorian health reform been successful?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545545/
https://www.ncbi.nlm.nih.gov/pubmed/33036631
http://dx.doi.org/10.1186/s12939-020-01294-1
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