Abstract
BackgroundIn 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage. While coverage indicators have increased, a systematic assessment of the impact of the reform on the delivery of health services at primary level is lacking. The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador.MethodsAmbulatory Care Sensitive Conditions (ACSC) are a subset of diseases where hospital admission is potentially avoidable by high quality well-functioning primary care. Thus, observing the behaviour of ACSC hospitalizations can serve as an indicator of how the primary health care level is performing. Crude and adjusted rates, stratified by sex, were calculated from ten selected ACSC hospitalization discharges during 22 years of data representing 11 years before and after the health reform. An interrupted time series analysis was then conducted by applying a negative binomial regression and adjusting for overdispersion and autocorrelation.ResultsOverall higher crude and adjusted rates for ACSC hospitalizations were observed in women compared to men; both increased gradually since the start of the observation, reaching a peak around 2010, and then started a downwards trend. In men, the incidence rate ratio increased significantly by 3 % per year during the period before the intervention. During the first year after intervention, an increase (13 %) was detected, and then a statistically significant 1 % decrease (IRR = 0.99; 95 % CI: 0.98, 0.99) was observed in the ACSC rate ratio per year in the period after the intervention. Similar trends and effect sizes were found for women.ConclusionsThe study revealed significant decreasing trends of the ACSC hospitalization rates in both sexes, indicating an improvement of the performance of the primary health care services following the 2008 national health reform. A continuous strengthening of the primary care model as well as a regular monitoring of ACSC hospitalization rates in the country is recommended. A health economic evaluation considering hospitalizations avoided and associated costs is also advisable.
Highlights
In 2008, Ecuador started a national health reform based on the principles of Alma Ata to achieve Universal Health Coverage
Starting in the 2000 s, Universal Healthcare Coverage (UHC) has been prominent in the political agendas of many Latin American countries based on comprehensive primary health care (PHC) models [3]
The aim of this study was to assess the impact of the 2008 health reform on the performance of primary health care services in Ecuador
Summary
Many countries throughout the world have recently framed their national health policies towards the goal of achieving Universal Healthcare Coverage (UHC) [1] This strategy advocates quality health care services accessible to all people according to need, as well as financial protection to avoid userseconomic hardship. Starting in the 2000 s, UHC has been prominent in the political agendas of many Latin American countries based on comprehensive primary health care (PHC) models [3] All countries in this region have committed to the implementation of UHC through its inclusion in their policy documents. These countries are making efforts to reform their health financing to increase the pooling of funds, guaranteeing access to an essential package of services and providing financial protection to the most vulnerable [4]. The review concluded that all countries were moving in the right direction but were still far from achieving full UHC [6]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
