RESUMO
Aim: To estimate the prevalence and factors associated with diabetes among older adults and compare the prevalence rate of a three-round national survey of the Mexican Health and Aging Study (MHAS). Methods: A cross-sectional study was conducted with data obtained from MHAS 2015 (n = 8167), 2018 (n = 7854), and 2021 (n = 8060), which comprised a nationally representative sample of older adults in Mexico. The measures included sociodemographic characteristics and health. A binary logistic regression model was used to identify the association between independent variables and self-reported diabetes. Results: The prevalence of diabetes was 26.3%, 27.7%, and 28.1% in 2015, 2018, and 2021, respectively. This prevalence decreased with age and was higher for female, urban older adults, those with multimorbidity, a lower level of education, and without social security coverage for the three years. Age was associated with a lower possibility of presenting diabetes ([OR = 0.79[0.71-0.89]] and [OR = 0.41[0.33-0.52]] in groups aged 75-84 years and ≥85 years, respectively). Females continue to be more likely to present diabetes than males (OR = 1.39 [95% CI 1.25-1.55]). Older adults living in rural areas are 20% less likely to present diabetes than those living in urban areas (OR = 0.80 [95% CI 0.69-0.93]). Uninsured older adults (OR = 1.35 [95% CI 1.20-1.53]), those who wear glasses (OR = 1.23 [95% CI 1.16-1.30]), those with multimorbidity (OR = 1.13 [95% CI 1.01-1.27]), and those who currently drink alcohol (OR = 1.12 [95% CI 1.00-1.25]) were significantly more likely to have diabetes. Conclusion: An elevated prevalence of diabetes was found in older adults in Mexico, while not having access to social security was associated with a higher possibility of presenting diabetes and living in a rural area was associated with a lower possibility of presenting diabetes. Detection, prevention, and control programs should be implemented to reduce the incidence and severity of the disease in older adults and, thus, prevent its associated complications.
Assuntos
Diabetes Mellitus , Autorrelato , Humanos , Idoso , Feminino , Masculino , México/epidemiologia , Estudos Transversais , Prevalência , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Fatores de Risco , Inquéritos Epidemiológicos , Fatores Etários , Envelhecimento , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
OBJECTIVE: Lymphedema affects >1 in 1000 Americans, most often resulting from breast cancer surgery. Conservative treatment, such as compression garments, combined decongestive therapy (CDT), and pneumatic compression pumps, is the current standard of care. Despite the wide availability of these therapies, lymphedema has remained undertreated worldwide. We investigated whether third-party insurance coverage might be a barrier to obtaining conservative treatment in the United States. METHODS: We conducted a cross-sectional analysis of publicly accessible insurance policies. A total of 58 insurers were included in accordance with their state enrollment data and market share. The analysis was conducted using a web-based search and individual telephone interviews. For those policies that extended coverage, the medical necessity criteria were abstracted. RESULTS: A total of 50 insurance companies (86%) had a policy in place addressing conservative management. Included in 37 policies (64%), compression garments were covered the least often (n = 33; 89%). Although CDT was included in only 22 policies (38%), it was universally covered. Noncalibrated pneumatic compression pumps were the most frequently addressed intervention (n = 46; 79%), significantly more often than CDT (P < .01) and were universally covered, significantly more often than were compression garments (P < .04). Criteria for reimbursement were present for more than one half of the policies that provided coverage. CONCLUSIONS: A large proportion of U.S. insurers provided coverage for conservative treatment of lymphedema. However, only 38% of the policies included a statement of coverage for CDT. Most of the policies that did provide coverage for these four therapies also had multiple criteria that were required to be met before considering reimbursement. These requirements could create barriers to the receipt of treatment.
Assuntos
Tratamento Conservador , Linfedema , Tratamento Conservador/efeitos adversos , Estudos Transversais , Humanos , Cobertura do Seguro , Linfedema/diagnóstico , Linfedema/terapia , Mastectomia , Estados UnidosRESUMO
While immigrants in the US suffer poor access to healthcare in general, access within immigrant populations varies notably by legal status and employment. Intersections between immigration, employment, and healthcare policy have shaped immigrants' access or exclusion from healthcare; however, little research has examined how immigrants experience and navigate these intersections. Drawing on social exclusion theory and the theory of bounded agency, we aimed to investigate Mexican and Chinese immigrants' experiences of exclusion from healthcare as one key dimension of social exclusion-and how this was shaped by interactions with the institutions of immigration and employment. The examination of two ethnic immigrant groups who live under the same set of policies allows for a focus on the common impacts of policy. We selected Mexican and Chinese immigrants as the two largest subgroups in California's Latinx and Asian immigrant population. We use a policy lens to analyze qualitative data from the mixed-methods Research on Immigrant Health and State Policy (RIGHTS) Study, involving 60 in-depth interviews with Mexican and Chinese immigrants in California between August 2018-August 2019. We identified two primary themes: pathways of social exclusion and access, and strategies used to address social exclusion. Findings show that immigrants' exclusion from healthcare is fundamentally linked to legal status and employment, and that immigrants navigate difficult choices between opportunities for improved employment and changes in legal status. We argue that multiple categories of legal status affect immigrants' employment opportunities and social position, which, in turn, translates to stratified healthcare access. Our findings support the literature establishing legal status as a mechanism of social stratification but challenge legal-illegal binary paradigms.
Assuntos
Emigrantes e Imigrantes , Emigração e Imigração , California , China , Emprego , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Isolamento SocialRESUMO
OBJECTIVES: Analyze the association between health insurance coverage and the use of health care services, dentist visits, and self-medication in a national sample of Mexican adults aged ≥50 years with diabetes. METHODS: Participants with diabetes taken from a subsample of the Mexican Health and Aging Study (MHAS-2018) (n = 3667) were examined, with data pertaining to the frequency of their doctor and dentist visits, residence, years of education, self-medication, and health insurance coverage (insured/uninsured) also collected. A logistic regression model was used to identify the association between independent variables and health insurance coverage, whereas Poisson regression models were also estimated to ascertain whether health insurance coverage was associated with the number of doctor and dentist visits. RESULTS: The prevalence of self-reported diabetes was 24.6%, whereas approximately 93.3% of subjects had visited a doctor, 40.6% had visited a dentist, and 20.3% self-medicated. Individuals with insurance coverage were 75% (Odds ratio [OR] = 1.75 [95% confidence interval {CI}1.32-2.31]; P < 0.001) more likely to have visited a doctor and 57% more likely to have visited a dentist (OR = 1.57 [95% CI 1.35-1.83]; P < 0.001) than uninsured adult subjects, while adults living in rural areas were 77% less likely to be insured than adults living in urban areas. Doctor and dentist visits [rate ratio {RR} = 1.32 (95% CI 1.28-1.35); P < 0.001] and [RR = 1.47 (95% CI 1.37-1.58); P < 0.001, respectively] were found to be positively associated with the insured members of the study population. CONCLUSION: A positive association was found between doctor and dentist visits in the population insured with diabetes. A major public health challenge is the population of diabetics who report being uninsured, wherein this population requires coverage to access the necessary clinical follow-up and control to prevent complications.
Assuntos
Diabetes Mellitus/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVES: We aim to explore how the current increase in Healthcare Insurance Coverage in Colombia potentially affected educational inequalities in cardiovascular disease (CVD) mortality from 1998 to 2015. METHODS: The official death database for the period 1998 to 2015, codified by cause of death for CVD (International Classification of Diseases, Tenth Revision: I00-I99) was analyzed (men = 279 537, women = 292 122). We compared Healthcare Insurance Coverage (HIC) fluctuations with the trends and annual percentage changes (APCs) in CVD age-standardized mortality rates (ASMRs), the rate ratios of the ASMR to educational level, and the Relative Index of Inequality (RII), which was used to measure the educational inequalities. RESULTS: Mortality from CVD is higher in men than in women (ASMR/men = 148.2; 95% CI: 147.6-148.7 vs ASMR/women = 139.4; 95% CI: 138.9-139.9). People with a lower educational level have an increased risk of dying prematurely owing to CVD, the higher inequalities being those for young women (RII = 2.62; 95% CI: 2.60-2.64). Inequalities by educational level (APC of the RII) grew at a rate of 2.5% per year in men and 1.7% in women, despite the steady increase of HIC throughout the period. From 1998 to 2011, there was a significant decrease in mortality rates owing to CVD (APC = -2.4% and APC = -2.1% for men and women, respectively). As of 2011, there was an increase only for men (APC = +3.9%). CONCLUSIONS: In Colombia, educational inequalities could be a cause of the worrying increase in mortality caused by CVD, which affects women more than men, whereas the HIC seem to be ineffective at reducing educational inequalities, and therefore mortality by CVD.
Assuntos
Doenças Cardiovasculares/mortalidade , Letramento em Saúde/normas , Cobertura do Seguro/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/psicologia , Colômbia , Escolaridade , Feminino , Letramento em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades/normas , Avaliação das Necessidades/estatística & dados numéricos , Análise de Regressão , Fatores SocioeconômicosRESUMO
OBJECTIVE: The characteristics of surgical patients were examined according to type of health insurance to determine whether differences existed between these groups. METHODS: We evaluated the characteristics of cases in the UPR General Surgery Department's database (entered from January 1, 2018 through December 31, 2018) by insurance type. The variables examined included age, gender, inpatient/outpatient status, wound classification, type of surgery, American Society of Anesthesiology (ASA) scores and whether a given patient had diabetes, was a smoker, or suffered from hypertension. This database had no trauma cases. RESULTS: Information was available for 5,097 cases during the study period. The mean age of the group was 51 (±22) years. The gender distribution indicated that 56% were women and 44% were men. The insurance types were distributed as follows: government/no insurance, 40%; Medicare, 12%; and private insurance, 48%. The government-insured/uninsured patients were younger (mean age, 41 ±24) and had had emergency surgery more frequently (18%) than had privately insured patients (10%). Medicare patients were significantly older (mean age, 72 ±12), and had had higher incidences of diabetes (46%) and hypertension (81%), presenting with ASA scores greater than or equal to 3 in 73% of cases. More privately insured individuals than those in other groups had had elective surgery (90%); 48% had been outpatients when they had their surgery, 58% had had clean wounds, and 61% of the patients having elective surgery were women. CONCLUSION: There were significant differences (P<.05) in the characteristics of patients with different types of health insurance. The frequency of emergency surgery was found to be significantly higher in the government-insured/uninsured group than in the privately insured group.
Assuntos
Seguro Saúde/classificação , Adulto , Fatores Etários , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências/epidemiologia , Feminino , Hospitais Universitários , Humanos , Hipertensão/epidemiologia , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Porto Rico/epidemiologia , Fatores Sexuais , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados UnidosRESUMO
To examine health insurance coverage among the 550,000 U.S.-born minors living in Mexico. Representative data from Mexico's 2018 National Survey of Demographic Dynamics was used to describe health coverage among persons aged 0-17 living in Mexico (N = 78,370). Multinomial logistic regression models were estimated to identify the association between birthplace (Mexico versus the United States) and health insurance coverage in Mexico. 39% of U.S-born minors living in Mexico in 2018 lacked health insurance compared to just 13% of Mexican-born minors. Logistic regression found that, net of potential confounders, being born in the United States was associated with 87% lower odds of being insured among minors in Mexico. U.S.-born minors disproportionately rely on private insurance programs and are particularly likely to be uninsured in the first year back from the United States. Special attention is needed to ensure access to care among U.S.-born minors in Mexico.
Assuntos
Emigrantes e Imigrantes , Acessibilidade aos Serviços de Saúde , Pessoas sem Cobertura de Seguro de Saúde , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , México , Inquéritos e Questionários , Estados UnidosRESUMO
Desde 2017 los miembros de la Comisión de Enfermedades Pulmonares Intersticiales Difusas de la Sociedad Chilena de Enfermedades Respiratorias hemos trabajado en la elaboración de las primeras guías de fibrosis pulmonar idiopática (FPI) del país, necesidad evidente para fomentar el diagnóstico precoz y adecuado de la enfermedad y establecer una base para posible incorporación de su cuidado en cobertura de seguros de salud especiales. Se elaboraron 5 preguntas de revisión de evidencia y el resto se trabajó en formato de preguntas de contexto. Un grupo de metodólogos graduaron la evidencia siguiendo la metodología GRADE.
Since 2017, the members of the Commission of Diffuse Interstitial Lung Diseases of the Chilean Society of Respiratory Diseases have worked in the development of the first guidelines of idiopathic pulmonary fibrosis (IPF) in the country, an obvious need to encourage early and adequate diagnosis of the disease and establish a basis for possible incorporation of IPF patients care into special health insurance coverage. Five evidence review questions were prepared and the remainder were worked out in context question format. A group of methodologists graduated the evidence following the GRADE methodology.
Assuntos
Humanos , Guias de Prática Clínica como Assunto , Fibrose Pulmonar Idiopática/história , Chile , Cobertura do SeguroRESUMO
Data from the Mexican Census reveal that between 2005 and 2015, nearly two million migrants returned voluntarily to Mexico from the United States. Currently, high rates of voluntary-return migration to Mexico continue at the same time that migration flows to the U.S. steadily decline. This return migration trend presents serious challenges for Mexico, a country that has long struggled to satisfy the health care demands of its population. However, little is known about return migrants' health care needs. In this study, we examine the health risk profiles and healthcare utilization for Mexican return migrants and the non-migrant population. We examine how these outcomes are affected by both the migration and return migration experience of the returnee population, while paying close attention to age-group differences. We employ inverse probability weighting regression adjustment (IPWRA) and logistic regression analysis of a sample of 348,450 respondents from the 2014 National Survey of Demographic Dynamics (ENADID) to test for differences in health conditions between those Mexican return migrants and non-migrants. We then turn to the Survey of Migration at Mexico's Northern Border (EMIF Norte, for its Spanish acronym) for the 2014-2017 period to further assess whether certain characteristics linked to aging and the migration experience influence the prevalence of chronic health conditions, and health insurance coverage among 17,258 returned migrants. Findings reveal that compared to non-migrants, returnees are more likely to be physically impaired. These poor health outcomes are influenced by the migration and return migration experience and vary by age group and duration of residence, the time that has elapsed since returning to Mexico. We do not find an association between return migration and mental or emotional distress. Policy implications are discussed in light of immigration reform and restrictions on eligibility for health insurance coverage for older adults in Mexico.
Assuntos
Emigração e Imigração/tendências , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Cobertura do Seguro , Americanos Mexicanos , Migrantes , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. METHODS: A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. RESULTS: In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. CONCLUSIONS: Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.
Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Guiana Francesa , Pesquisas sobre Atenção à Saúde , Gastos em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Migrantes/estatística & dados numéricos , Adulto JovemRESUMO
El Aseguramiento Universal en Salud constituye una de las principales políticas públicas impulsadas en la última década en nuestro país, y se ha mantenido por más de cuatro administraciones nacionales en la agenda política. Los avances en este proceso pueden verse reflejados en el incremento en la cobertura de afiliación a algún tipo de seguro de salud, que para el caso del Seguro Integral de Salud (SIS), fue ampliada de 19,4% en el año 2006 a 50,2% para el año 2015 (Encuesta Nacional de Hogares - ENAHO). Sin embargo, es posible evidenciar que mientras en el 2006 el 44,9% de los afiliados al SIS buscaban atención por problemas de salud en establecimientos del MINSA o de las redes de salud públicas de los Gobiernos Regionales, en el año 2015 este porcentaje disminuyó a 31,7%. Estos resultados obligan a prestar atención a otros factores que estarían restringiendo la mejora en el acceso a los servicios de salud, especialmente en pobladores pobres protegidos financieramente. Entre los retos para incrementar la cobertura prestacional se encuentran la brecha de infraestructura y equipamiento de servicios de salud, la poca articulación de los establecimientos de salud del primer nivel de atención, la subutilización de la oferta pública existente y recurso humano no bien remunerado con escasos o nulos incentivos.
Health Universal Coverage is one of the principal public policy impulsed in the last decade in our country, despite four different national administrations their importance remains in the agenda. The advances in this process are evident in the increment of the insurance coverage, that in case of Seguro Integral de Salud (SIS) was broaded from 19,4% in 2006 to 50,2% in 2015 (National Household Survey - NHS). However, it is real that while in 2006, 44,9% of affiliates to SIS sought attention for health problems in public health establishments of national, regional o local level, this proportion decrease to 31,7% in 2015. These results force us to pay attention to other factors that would be restricting the improvement in the health services access, especially in poor people protected financially. Among the challenges to increase the provisional coverage are the gap in infrastructure and health services equipment, the poor articulation of health care facilities at the primary care, the underuse of the existing public offering and poorly remunerated human resources with little or no incentives.
RESUMO
OBJECTIVE: To test the impact of the dependent coverage expansion (DCE) on insurance disparities across race/ethnic groups. DATA SOURCES/STUDY SETTING: Survey data from the National Survey of Drug Use and Health (NSDUH). STUDY DESIGN: Triple-difference (DDD) models were applied to repeated cross-sectional surveys of the U.S. adult population. DATA COLLECTION/EXTRACTION METHODS: Data from 6 years (2008-2013) of the NSDUH were combined. PRINCIPAL FINDINGS: Following the DCE, the relative odds of insurance increased 1.5 times (95 percent CI 1.1, 1.9) among whites compared to blacks and 1.4 times (95 percent CI 1.1, 1.8) among whites compared to Hispanics. CONCLUSIONS: Health reform efforts, such as the DCE, can have negative effects on race/ethnic disparities, despite positive impacts in the general population.
Assuntos
Etnicidade/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Grupos Raciais/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Patient Protection and Affordable Care Act/legislação & jurisprudência , Fatores Socioeconômicos , Estados Unidos , Adulto JovemRESUMO
Beginning in 2001 Mexico established Seguro Popular, a health insurance scheme aimed at providing coverage to its large population of uninsured people. While recent studies have evaluated the health benefits of Seguro Popular, evidence on perinatal health outcomes is lacking. We conducted a population-based study using Mexican birth certificate data for 2010 to assess the relationship between enrollment in Seguro Popular and preterm delivery among first-time mothers with singleton births in Mexico. Seguro Popular enrollees with no formal education had a far greater reduction in risk of preterm delivery, while enrollees with any formal education experienced only slight reduction in risk, after maternal age, marital status, education level, mode of delivery, and trimester in which prenatal care was initiated were controlled for. Seguro Popular appears to facilitate access to health services among mothers with low levels of education, reducing their risk for preterm delivery. Providing broad-scale health insurance coverage may help improve perinatal health outcomes in this vulnerable population.
Assuntos
Escolaridade , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/organização & administração , Saúde Materna/economia , Nascimento Prematuro/epidemiologia , Adulto , Declaração de Nascimento , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Cobertura do Seguro/economia , Idade Materna , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , México , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Nascimento Prematuro/prevenção & controle , Medição de Risco , Fatores SocioeconômicosRESUMO
Even though access to health insurance in Colombia has improved since the implementation of the 1993 health reforms (Law 100), universal coverage has not yet been accomplished. There is still a segment of the population under the low-income (subsidized) health insurance policy or without health insurance altogether. The purpose of this research was to identify preferences and behavior regarding health insurance among the subsidized rural population in La Guajira, Colombia, and to understand why that population remains under the subsidized health insurance policy. The field experiment gathered information from 400 households regarding their socioeconomic situation, health conditions, and preferences for health insurance characteristics. Results suggest that the surveyed population gives priority to expanded family coverage, physician and hospital choice, and access to specialists, rather than to attributes associated with co-payments or premiums. That indicates that people value healthcare benefits and family coverage more than health insurance expenses, and policy makers could use these preferences to enroll subsidized population into the contributory regime.
Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde , População Rural/estatística & dados numéricos , Adulto , Colômbia , Feminino , Financiamento Governamental/organização & administração , Nível de Saúde , Humanos , Cobertura do Seguro/organização & administração , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Masculino , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
Despite enacting a universal healthcare system in 1993, many Colombians do not participate. Understanding perceptions of the system could help the government market certain features or adjust benefits in order to increase enrollment. Using La Guajira, Colombia, as a case study, we surveyed uninsured rural households regarding insurance preferences, values and beliefs, and perceptions of available services. Four hundred heads of households responded in La Guajira, Colombia. Respondents reported high levels of long-term uninsurance. Overall, the quality of services in the government-run system is perceived as better than being uninsured, but there appear to be constraints on enrollment. Rural Colombians value more family coverage and better choice of physicians, but offering better benefits may not be enough. Many cited access barriers, so reducing these barriers may also increase enrollment. Further surveys in other parts of Colombia should be undertaken to confirm results.
Assuntos
Cobertura do Seguro , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde , População Rural , Cobertura Universal do Seguro de Saúde , Adulto , Colômbia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
Objetivos. Estudiar las variaciones de la tasa de mortalidad infantil (TMI) en los departamentos de Colombia durante el período 2003-2009, examinar la persistencia de las variaciones entre los departamentos sobre el tiempo y relacionarlas con el impacto de las condiciones socioeconómicas y la disponibilidad de servicios de salud, sobre la mortalidad infantil. Materiales y métodos. Utilizando estadísticas vitales y relacionando datos socioeconómicos y de servicios de salud, se analizaron tres aspectos: la variación de la TMI departamental (2003-2009), la relación entre la TMI departamental y determinantes claves en el tiempo, y las líneas de causalidad e impacto relativo de los diferentes factores. Se emplearan ecuaciones estructurales. Resultados. Se encontró una razón de 4,7 entre la mayor y menor TMI departamental (2009), esta podría estar subestimada principalmente por el subregistros en departamentos de bajos ingresos. Hay una relación negativa entre la TMI departamental con el tiempo y variables altamente correlacionadas, como educación de la madre, ingreso per cápita, cobertura de aseguramiento y acceso a servicios. Conclusiones. El efecto del aseguramiento, disponibilidad de camas privadas y atención médica, es superior al impacto de mejores condiciones socioeconómicas sobre la TMI. La oferta de servicios no parece estar influenciada por una política racional, los recursos no se asignan de acuerdo con las necesidades, sino con el desarrollo general. Las camas privadas se hacen disponibles donde hay mejor aseguramiento en salud y menor TMI.
Objectives. To study the variations in infant mortality rate (IMR) across Colombias 33 administrative departments over the period 2003-2009, examine persistency of variations across departments over time, and relate those variations to the impact of socio-economic conditions and availability of care on IMR. Materials and methods. Using vital statistics and related socio-economic data we establish three types of analysis according to: (a) the variation of the departmental IMR (2003-2009), (b) the association between the departmental IMR and its key determinants over time, and (c) the lines of causality and relative impact of different factors, by using structural equations. Results. The 4.7 fold ratio between the highest and lowest departmental IMR (2009) may be underestimated considering underreporting, especially in low-income departments. There is a negative association between the departmental IMR with time and a set of highly correlated variables, such as the mother education, income per capita, health insurance level and access to services. Conclusions. The effect of better insurance, availability of private beds, and having doctors attending mothers, eclipse the impact of better socioeconomic conditions. The range of services does not appear to be influenced by a rational policy; resources are not allocated according to the need, but with the general development. Private beds are made available where there is better health insurance.