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Socioeconomic inequalities in women´s access to health care: has Ecuadorian health reform succeeded?
Edy Quizhpe
Universidad Técnica del Norte
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7111-5030
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at International Journal for Equity in Health.
Background
Over the last twelve years, Ecuador has implemented a comprehensive health sector reform to ensure equitable access to health care services according to health needs. 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. This study assessed whether the health care reform implemented in the 2007 - 2017 decade contributed to reducing the socioeconomic inequalities in women´s health care access.
Methods
This study was based on two waves of the Living Standards Measurement Survey conducted in Ecuador in 2006 and 2014. Data from women of reproductive age (15 to 49 years) was analysed to evaluate health care coverage in 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 inequality reductions in skilled birth attendants 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 decrease by education was observed for modern contraceptive use.
Conclusions
While most socioeconomic inequalities in skilled birth attendance decreased during the reform, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further work is needed to address the social determinants of these health inequalities.
Keywords
Health Inequality, Health Reform, Universal Health Coverage, Socioeconomic Determinants, Ecuador
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CURRENT STATUS: Published
Published
On 09 Oct, 2020
No community comments so far
Editorial decision: Accept
On 26 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
Editor assigned
On 21 Sep, 2020
Submission checks complete
On 20 Sep, 2020
Editor invited
On 20 Sep, 2020
No comments provided
Editorial decision: Minor Revision
On 07 Sep, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Review #1 received
Received 27 Aug, 2020
Editor assigned
On 10 Aug, 2020
Reviewers invited
Invitations sent on 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
No comments provided
Editorial decision: Minor Revision
On 29 Jun, 2020
Review #3 received
Received 26 Jun, 2020
Review #1 received
Received 21 Jun, 2020
Reviewer #3 agreed
On 05 Jun, 2020
Review #2 received
Received 05 Jun, 2020
Reviewer #2 agreed
On 05 Jun, 2020
Editor assigned
On 03 Jun, 2020
Reviewers invited
Invitations sent on 03 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
Version 1
Posted 30 Mar, 2020
No comments provided
Editorial decision: Major Revision
On 04 May, 2020
Review #2 received
Received 02 May, 2020
Review #3 received
Received 22 Apr, 2020
Review #1 received
Received 20 Apr, 2020
Reviewer #3 agreed
On 16 Apr, 2020
Reviewer #2 agreed
On 14 Apr, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Reviewers invited
Invitations sent on 29 Mar, 2020
Editor assigned
On 27 Mar, 2020
First submitted
On 26 Mar, 2020
Submission checks complete
On 26 Mar, 2020
Editor invited
On 26 Mar, 2020
Metrics
Comments: 0
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Subject Areas
Health Policy
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This preprint is under consideration at International Journal for Equity in Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Socioeconomic inequalities in women´s access to health care: has Ecuadorian health reform succeeded?
Edy Quizhpe
Universidad Técnica del Norte
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7111-5030
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 09 Oct, 2020
No community comments so far
Editorial decision: Accept
On 26 Sep, 2020
Reviewers invited
Invitations sent on 22 Sep, 2020
Editor assigned
On 21 Sep, 2020
Submission checks complete
On 20 Sep, 2020
Editor invited
On 20 Sep, 2020
No comments provided
Editorial decision: Minor Revision
On 07 Sep, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Review #1 received
Received 27 Aug, 2020
Editor assigned
On 10 Aug, 2020
Reviewers invited
Invitations sent on 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
No comments provided
Editorial decision: Minor Revision
On 29 Jun, 2020
Review #3 received
Received 26 Jun, 2020
Review #1 received
Received 21 Jun, 2020
Reviewer #3 agreed
On 05 Jun, 2020
Review #2 received
Received 05 Jun, 2020
Reviewer #2 agreed
On 05 Jun, 2020
Editor assigned
On 03 Jun, 2020
Reviewers invited
Invitations sent on 03 Jun, 2020
Reviewer #1 agreed
On 03 Jun, 2020
Submission checks complete
On 02 Jun, 2020
Editor invited
On 02 Jun, 2020
Version 1
Posted 30 Mar, 2020
No comments provided
Editorial decision: Major Revision
On 04 May, 2020
Review #2 received
Received 02 May, 2020
Review #3 received
Received 22 Apr, 2020
Review #1 received
Received 20 Apr, 2020
Reviewer #3 agreed
On 16 Apr, 2020
Reviewer #2 agreed
On 14 Apr, 2020
Reviewer #1 agreed
On 31 Mar, 2020
Reviewers invited
Invitations sent on 29 Mar, 2020
Editor assigned
On 27 Mar, 2020
First submitted
On 26 Mar, 2020
Submission checks complete
On 26 Mar, 2020
Editor invited
On 26 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at International Journal for Equity in Health.
Background
Over the last twelve years, Ecuador has implemented a comprehensive health sector reform to ensure equitable access to health care services according to health needs. 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. This study assessed whether the health care reform implemented in the 2007 - 2017 decade contributed to reducing the socioeconomic inequalities in women´s health care access.
Methods
This study was based on two waves of the Living Standards Measurement Survey conducted in Ecuador in 2006 and 2014. Data from women of reproductive age (15 to 49 years) was analysed to evaluate health care coverage in 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 inequality reductions in skilled birth attendants 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 decrease by education was observed for modern contraceptive use.
Conclusions
While most socioeconomic inequalities in skilled birth attendance decreased during the reform, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further work is needed to address the social determinants of these health inequalities.