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. 2020 Oct 26;19(1):127.
doi: 10.1186/s12939-020-01237-w.

Horizontal inequity in the use and access to health care in Uruguay

Cecilia González  1 , Patricia Triunfo  2
Affiliations

Horizontal inequity in the use and access to health care in Uruguay

Cecilia González et al. Int J Equity Health. .

Abstract
in English, Spanish

Background: In 2007 Uruguay began a reform in the health sector towards the construction of a National Integrated Health System (SNIS), based on public insurance with private and public provision. The main objective of the reform was to universalize access to health services.

Methods: Data comes from the first National Health Survey conducted in 2014 and available since 2016. Concentration indices are calculated for different indicators of use and access to medical services, for the population 18 years of age and older, and for different subgroups (age, sex, region and type of coverage). The indices are decomposed into need and non-need variables and the contribution of each of them to total inequality is analyzed. Horizontal inequity is calculated.

Results: Results show pro-rich inequality for medical consultations, medical analysis, medication use and non-access due to costs. Type of health coverage is the variable that explains most of the inequality: private coverage is pro-rich while public coverage is pro-poor. Income does not appear as significant to explain inequality, except for access issues. From the population subgroups' analysis, there is no evidence of inequality for the group of 60 years old or more. On the other hand, studies such as Pap Smear and prostate, which may be associated with preventive studies,, shows pro-rich inequality and, in both cases, the main contribution is given by income.

Conclusions: The analysis of health inequity shows pro-rich inequity in medical consultations, medical analysis, medication use and lack of access due to costs. The type of health coverage explains these inequalities; in particular, private coverage is pro-rich. These results suggest that the type of health coverage are capturing the income factor, since higher income individuals will be more likely to be treated in the private system.

Antecedentes: En 2007 el gobierno uruguayo comenzó una reforma del sector salud tendiente a la construcción de un Sistema Nacional Integrado de Salud, basado en un seguro público con provisión privada y pública. El principal objetivo de la reforma fue universalizar el acceso a los servicios de salud.

Metodología: A partir de la primera Encuesta Nacional de Salud realizada en 2014 y disponible en 2016, se calculan índices de concentración para diversos indicadores de uso y acceso a servicios médicos, para la población de 18 años y más, y para diferentes subgrupos (edad, sexo, región y tipo de cobertura), a la vez que se descomponen los índices en variables de necesidad y no necesidad, analizando la contribución de cada una de dichas variables a la desigualdad total, y calculando la inequidad horizontal.

Resultados: Los resultados muestran inequidad horizontal pro rico para las consultas médicas, análisis médicos, uso de medicamentos y falta de acceso por motivo de costos. El tipo de cobertura de salud es la variable que más explica la desigualdad: la cobertura privada es pro rico mientras que la cobertura pública es pro pobre. El ingreso no resulta significativo para explicar la desigualdad excepto para los problemas de acceso.

Del análisis de subgrupos de población se destaca que no se encuentra evidencia de inequidad para el grupo de 60 años y más. Por otro lado, estudios como el PAP y de próstata, que pueden ser asociados a conductas preventivas, muestran inequidad pro rico, y en ambos casos la principal contribución está dada por el ingreso.

Conclusiones: El análisis de la inequidad en salud muestra inequidad pro rico en consultas médicas, análisis médicos, uso de medicamentos y problemas de acceso por motivo de costos. El tipo de cobertura de salud explica en gran parte estas desigualdades, en particular, la cobertura privada es pro rico. Estos resultados sugieren que el tipo de cobertura médica estaría captando el factor ingreso, ya que los individuos de mayores ingresos tienen mayor probabilidad de atenderse en el sistema privado.

Keywords: Concentration index; Health inequality; Uruguay.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Decomposition of the Concenration Index, population over 18 years old, Uruguay 2014
Fig. 2
Fig. 2
Concentration curves for health care utilization
See this image and copyright information in PMC

References

    1. Almeida G, Sarti FM. Measuring evolution of income-related inequalities in health and health care utilization in selected Latin American and Caribbean countries. Rev Panam Salud Publica. 2013;33(2):83–89. doi: 10.1590/S1020-49892013000200002. - DOI - PubMed
    1. Almeida G, Sarti FM, Ferreira FF, Diaz MDM, Campino ACC. Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998-2008. Rev Panam Salud Publica. 2013;33:90–97. doi: 10.1590/S1020-49892013000200003. - DOI - PubMed
    1. Balsa A, Ferrés D, Rossi M, Triunfo P. Inequidades socioeconómicas en el uso de servicios sanitarios del adulto mayor montevideano. Estud Econ. 2009;24(47):35–88.
    1. Balsa A, Rossi M, Triunfo P. Horizontal inequality in access to health care in four south American cities. Rev Econ Rosario. 2011;14(1):31–56.
    1. Barraza-Lloréns M, Panopoulou G, Díaz BY. Income-related inequalities and inequities in health and health care utilization in Mexico, 2000-2006. Rev Panam Salud Publica. 2013;33:122–130. doi: 10.1590/S1020-49892013000200007. - DOI - PubMed

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