Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil
Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil
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DOI：
10.1016/j.socscimed.2014.01.054
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发表时间：
2014-04-01
影响因子：
5.4
通讯作者：
Luisa Vazquez, Maria
中科院分区：
文献类型：
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作者：
Garcia-Subirats, Irene;Vargas, Ingrid;Luisa Vazquez, Maria
关于从最初寻求医疗保健到解决健康问题所遇到的障碍，换言之，关于在其广泛领域内获得医疗保健的问题，现有的全面研究很少。对于哥伦比亚和巴西这两个拥有不同医疗体系但共同声明原则的国家，迄今为止尚未进行此类分析。本文比较了在其广泛的领域在每个国家的两个城市的影响因素，通过一项横断面研究的基础上调查的多级概率样本的人谁有至少一个健康问题在过去的三个月内（2163在哥伦比亚和2155在巴西）。结果显示，在这两个样本中，获得医疗保健的重要障碍，一旦考虑到社会人口特征和健康需求的差异，国家之间和国家内部存在显着差异。在哥伦比亚的研究地区，在最初获得保健和解决问题方面遇到的障碍最大，在巴西的研究地区，在获得保健服务方面也遇到同样的障碍。在服务的使用方面也可以发现差异：在哥伦比亚，地理和经济障碍更大，需要保险公司的授权，这一点更为重要，而在巴西，由于保健中心、医生和药物有限，导致等待时间更长。在哥伦比亚，根据入学情况和保险计划，以及在巴西的地区之间，也存在差异。这些障碍似乎与哥伦比亚系统的分散性和非普遍性、保险公司的参与以及巴西公共系统长期资金不足有关。需要进一步研究，但所获得的结果揭示了两国卫生政策需要解决的关键问题。(C)2014作者由爱思唯尔有限公司出版。保留所有权利。
There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries. (C) 2014 The Authors. Published by Elsevier Ltd. All rights reserved.