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. 2020 Mar 4:44:e11.
doi: 10.26633/RPSP.2020.11. eCollection 2020.

Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries

Natalia Houghton  1 , Ernesto Bascolo  1 , Amalia Del Riego  1
Affiliations

Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries

Natalia Houghton et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish, Portuguese

Objective: To present summary measures of socioeconomic inequalities in access barriers to health services in Colombia, El Salvador, Paraguay, and Peru.

Methods: This cross-sectional study used data from nationally - representative household surveys in Colombia, El Salvador, Peru, and Paraguay to analyze income-related inequalities in barriers to seeking health services. Households that reported having a health problem (disease/accident) and not seeking professional health care were considered to be facing access barriers. The measures of inequality were the slope index of inequality and relative index of inequality.

Results: Inequality trends were mixed across the four countries. All showed improvement, but large inequality gaps persisted between the highest and lowest income quintiles, despite health care reforms. Relative inequality gaps were highest in Colombia (60%), followed by Paraguay (30%), Peru (20%), and El Salvador (20%).

Conclusions: The effect of national policy initiatives on equity to accessing health services should be the object of future analysis. There is also a need for research on national and regional monitoring of access barriers and explanatory factors for why people do not seek care, even when having a health problem.

Objetivo: Presentar algunas mediciones de las desigualdades socioeconómicas que representan obstáculos para el acceso a los servicios de salud en Colombia, El Salvador, Paraguay y Perú.

Métodos: En este estudio transversal se tomaron datos de encuestas realizadas en hogares representativas a nivel nacional en Colombia, El Salvador, Perú y Paraguay. Mediante estos datos se analizaron las desigualdades en los ingresos como obstáculos para recurrir a los servicios de salud. Los hogares donde se informó algún problema de salud (enfermedad o accidente) y sus habitantes no recurrieron a ningún tipo de atención profesional fueron considerados como población que enfrenta obstáculos para acceder a estos servicios. Para medir la desigualdad se usó el índice de desigualdad de la pendiente y el índice relativo de desigualdad.

Resultados: Las tendencias de desigualdad fueron divergentes entre estos países. Se observó un grado de avance en cada país, aunque subsistieron grandes brechas entre el quintil de ingresos superiores y el inferior, a pesar de que hubo reformas en la atención de salud. Las brechas en cuanto al índice relativo de desigualdad fueron más elevadas en Colombia (60%), seguido de Paraguay (30%), Perú (20%) y El Salvador (20%).

Conclusiones: La repercusión que tienen las iniciativas de política nacional sobre la igualdad de acceso a los servicios de salud debería ser objeto de análisis en un futuro. Asimismo, es necesario que se realicen investigaciones en cuanto al seguimiento a nivel nacional y regional de los obstáculos al acceso a los servicios de salud y los factores explicativos que indiquen porqué las personas no acuden a los servicios incluso cuando presentan un problema de salud.

Objetivo: Apresentar indicadores das desigualdades socioeconómicas no acesso aos serviços de saúde na Colombia, El Salvador, Paraguai e Peru.

Métodos: Este estudo transversal utilizou dados de pesquisas domiciliares representativas da realidade nacional na Colómbia, El Salvador, Peru e Paraguai com o objetivo de analisar as desigualdades relacionadas a renda no acesso aos serviços de saúde. Os domicílios que relataram a presença de um problema de saúde (doença/acidente) e nao buscaram cuidados de saúde profissionais foram considerados como domicílios que apresentavam barreiras no acesso aos serviços de saúde. Os indicadores de desigualdade foram o indice absoluto de desigualdade (slope index of inequality, SII) e o indice relativo de desigualdade.

Resultados: As tendencias relativas a desigualdade foram mistas nos quatro países. Todos apresentaram melhorias, mas ainda persistem grandes disparidades entre os quintis com renda mais alta e mais baixa, apesar das reformas nos sistemas de saúde. A desigualdade relativa foi mais elevada na Colómbia (60%), seguida do Paraguai (30%), Peru (20%) e El Salvador (20%).

Conclusões: O efeito das iniciativas políticas nacionais sobre a equidade no acesso aos serviços de saúde deve ser o tema de análises futuras. Também é preciso pesquisar o monitoramento nacional e regional das barreiras no acesso aos serviços e os fatores que explicam por que as pessoas nao buscam cuidados de saúde, mesmo quando apresentam um problema de saúde.

Keywords: Colombia; El Salvador; Health services accessibility; Latin America; Paraguay; Peru; health care reform; socioeconomic gradient in health.

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Conflict of interest statement

Conflicts of interest. None declared

Figures

FIGURE 1.
FIGURE 1.. Sample size flow chart for a study of access barriers to health services in four Latin American countries, 2010 - 2016
FIGURE 2.
FIGURE 2.. Equiplot of inequality trends of barriers in seeking health services, selected Latin American countries, 2010-2016
See this image and copyright information in PMC

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