Abstract
BackgroundOver the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. 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. The present study assesses whether the health care reforms implemented in the decade between 2007 and 2017 have contributed to reducing the socioeconomic inequalities in women’s health care access.MethodsThe present study was based on two waves (2006 and 2014) of the Living Standards Measurement Survey conducted in Ecuador. Data from women of reproductive age (15 to 49 years) were analysed to evaluate health care coverage across 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.ResultsAccess to health care increased in the three studied outcomes during the health sector reform. Significant reductions in inequality in skilled birth attendance 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 poorer education was observed for modern contraceptive use.ConclusionsWhile most socioeconomic inequalities in skilled birth attendance decreased during the reform period, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further studies are needed to address the social determinants of these health inequalities.
Highlights
Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need
This, and the potential lessons learnt from other countries who are aiming for Universal Health Coverage (UHC), was acknowledged internationally when, in 2015, The Lancet published a collection of papers charting the complex political, economic, and social forces that shaped health policy-making when Latin American countries tried to implement health system reforms [8]
The aim of this study was to assess whether health care reform had any impact on progress towards UHC in Ecuador, and whether it has contributed to decreasing socioeconomic inequalities in three indicators of health care access amongst women
Summary
Over the last 12 years, Ecuador has implemented comprehensive health sector reform to ensure equitable access to health care services according to need. This, and the potential lessons learnt from other countries who are aiming for UHC, was acknowledged internationally when, in 2015, The Lancet published a collection of papers charting the complex political, economic, and social forces that shaped health policy-making when Latin American countries tried to implement health system reforms [8]. These articles provided the most extensive review of the historical processes of several countries and their challenges over the previous 30 years [9]. This was due to internal and external factors such as huge fragmentation, poor delivery, and unsustainable financing [11,12,13]
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