Socioeconomic inequalities in women´s access to health care: has Ecuadorian health reform succeeded?
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.
On 09 Oct, 2020
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On 27 Aug, 2020
Received 27 Aug, 2020
On 10 Aug, 2020
Invitations sent on 10 Aug, 2020
On 09 Aug, 2020
On 09 Aug, 2020
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On 05 Jun, 2020
Received 05 Jun, 2020
On 05 Jun, 2020
On 03 Jun, 2020
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On 03 Jun, 2020
On 02 Jun, 2020
On 02 Jun, 2020
Posted 30 Mar, 2020
On 04 May, 2020
Received 02 May, 2020
Received 22 Apr, 2020
Received 20 Apr, 2020
On 16 Apr, 2020
On 14 Apr, 2020
On 31 Mar, 2020
Invitations sent on 29 Mar, 2020
On 27 Mar, 2020
On 26 Mar, 2020
On 26 Mar, 2020
On 26 Mar, 2020
Socioeconomic inequalities in women´s access to health care: has Ecuadorian health reform succeeded?
On 09 Oct, 2020
On 26 Sep, 2020
Invitations sent on 22 Sep, 2020
On 21 Sep, 2020
On 20 Sep, 2020
On 20 Sep, 2020
On 07 Sep, 2020
On 27 Aug, 2020
Received 27 Aug, 2020
On 10 Aug, 2020
Invitations sent on 10 Aug, 2020
On 09 Aug, 2020
On 09 Aug, 2020
On 29 Jun, 2020
Received 26 Jun, 2020
Received 21 Jun, 2020
On 05 Jun, 2020
Received 05 Jun, 2020
On 05 Jun, 2020
On 03 Jun, 2020
Invitations sent on 03 Jun, 2020
On 03 Jun, 2020
On 02 Jun, 2020
On 02 Jun, 2020
Posted 30 Mar, 2020
On 04 May, 2020
Received 02 May, 2020
Received 22 Apr, 2020
Received 20 Apr, 2020
On 16 Apr, 2020
On 14 Apr, 2020
On 31 Mar, 2020
Invitations sent on 29 Mar, 2020
On 27 Mar, 2020
On 26 Mar, 2020
On 26 Mar, 2020
On 26 Mar, 2020
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.