Health equity in an unequal country: the use of medical services in Chile
Health equity in an unequal country: the use of medical services in Chile
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DOI：
10.1186/1475-9276-11-81
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发表时间：
2012-12-18
影响因子：
4.8
通讯作者：
Vasquez, Felipe
中科院分区：
文献类型：
--
作者：
Paraje, Guillermo;Vasquez, Felipe
简介：智利最近实施了一项卫生改革（AUGE改革），目的是缩小获得医疗保健的社会经济差距。这一改革并不是要取消与公共保险并存的私人保险制度，而是要确保所有人都能以合理的费用和质量保证获得最低条件，以涵盖一组重要的健康状况。本文的主要目的是询问发生了什么事后，改革完全implemented.Methods：浓度和横向不平等指数估计使用全科医生，专家，急诊室就诊，实验室和X光检查和住院天数。这些指数的变化（改革前和改革后）被分解，遵循Zhong（2010）。一种“平均效应”（如果医疗服务的差别使用均匀分布，这些指数将如何变化）和“分布效应”（在平均使用量不变的情况下，这些指数将如何变化）。浓度指数的变化主要是由于所有病例的平均效应，但专科医生（“分布效应”占主导地位）和住院天数（这些效应都不占主导地位）除外。这意味着，通过向社会经济群体提供更多的服务，减少了在使用服务方面的不平等。另一方面，横向不公平指数的变化是由于分布的影响，在GP的情况下，ER访问和住院天数;由于平均效果的情况下，X射线。在前三种情况下，指数降低了它们的扶贫程度，这意味着在改革之后，相对较高的社会经济群体更多地使用这些服务（相对于他们的需求而言）。在X射线的情况下，增加使用是负责改善其横向不公平index.Conclusions：增加平均使用的医疗保健服务后，AUGE改革并不总是导致改善公平使用这种服务在大多数服务。这表明，公平使用医疗服务仍然存在障碍（例如，G.医疗人力资源不足、财政障碍、能力限制等）在改革后仍然存在。
Introduction: A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper's main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented.Methods: Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A "mean effect" (how these indices would change if the differential use in healthcare services were evenly distributed) and a "distribution effect" (how these indices would change with no change in average use) were obtained.Results: Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where "distribution effect" prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index.Conclusions: The increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e. g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform.