Equity in health and health care in Peru, 2004 - 2008
Equity in health and health care in Peru, 2004 - 2008
复制标题
DOI：
10.1590/s1020-49892013000200008
复制
发表时间：
2013-02-01
期刊：
影响因子：
--
通讯作者：
Almeida, Gisele
中科院分区：
文献类型：
--
作者：
Petrera, Margarita;Valdivia, Martín;Almeida, Gisele
目标。这项研究评估了最近积极的经济趋势和有利于穷人的卫生政策是否导致了更多的健康公平，并探索了解释这种变化的关键因素。这项研究的重点是从2004年和2008年秘鲁全国住户调查(Encuesta Nacional De Hogares)获得的健康状况(自我报告发病率)和保健服务使用情况的衡量标准的演变。它集中于与社会经济地位相关的健康不平等，并使用五分位数之间的差异(梯度)、集中度指数在进行和不基于需求调整的情况下，以及分解分析。调查结果显示，在健康状况衡量标准中，不平等程度较低，自报健康问题的不平等程度略高于穷人，自报慢性病的不平等程度略高于富人。2004年至2008年期间，使用治疗服务的不平等现象显著减少，而使用预防性服务的不平等现象略有增加。同期，医院和牙科服务的使用情况保持不变。自我报告的发病率指标的局限性可能低估了社会经济群体健康不平等的结果。在分析过程中同时出现的一些积极因素--即家庭平均收入增加、经济不平等程度降低、Juntos有条件现金转移计划以及公共医疗保险的逐步扩大--可以解释使用治疗性医疗服务的公平性的改善。鉴于扩大SIS是促进秘鲁卫生公平的主要公共政策，至关重要的是，未来的扩大步骤应包括一项战略，将其对改善卫生公平的贡献与其他积极的社会经济趋势的贡献区分开来。
Objective. This study evaluates whether recent positive economic trends and pro-poor health policies have resulted in more health equity and explores key factors that explain such change.Methods. This study focuses on the evolution of measures of health status (self-reported morbidity) and use of health care services obtained from the 2004 and 2008 rounds of the Peruvian National Household Survey (Encuesta Nacional de Hogares). It concentrates on health inequalities associated with socioeconomic status and uses interquintile differences (gradient), concentration indices with and without needs-based adjustments, and decomposition analysis.Results. Findings show a low level of inequality in measures of health status, with a slightly pro-poor inequality in self-reported health problems and a slightly pro-rich inequality in self-reported chronic illness. Inequity in the use of curative services declined significantly between 2004 and 2008, while inequity in the use of preventive services increased slightly. Use of hospital and dental services remained unchanged during the same period.Conclusions. Limitations of self-reported morbidity measures probably underestimate the results of health inequalities across socioeconomic groups. Improved equity in the use of curative health services can be explained by a number of positive factors that occurred concurrently during the analysis-namely, increased mean household income, reduced economic inequality, the Juntos conditional cash transfer program, and gradual expansion of public health insurance, Seguro Integral de Salud (SIS). Given that SIS expansion is the main public policy for promoting health equity in Peru, it is crucial that future steps in expansion come with a strategy to isolate its contribution to health equity improvements from that of other positive socioeconomic trends.