Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries

Authors

Javier Roberti, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Epidemiology and Public Health Research Centre, National Council for Scientific and Technical Research, Buenos Aires, Argentina. Electronic address: jroberti@iecs.org.ar.
Hannah H. Leslie, Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Svetlana V. Doubova, Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico.
Jesús Medina Ranilla, School of Public Health, Cayetano Heredia University, Lima, Peru.
Agustina Mazzoni, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Laura Espinoza, School of Public Health, Cayetano Heredia University, Lima, Peru.
Renzo Calderón, School of Public Health, Cayetano Heredia University, Lima, Peru; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
Catherine Arsenault, Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Ezequiel García-Elorrio, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
Patricia J. García, School of Public Health, Cayetano Heredia University, Lima, Peru.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

The Lancet. Global health

Volume

12

Issue

1

DOI

10.1016/S2214-109X(23)00488-6

Abstract

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

APA Citation

Roberti, Javier; Leslie, Hannah H.; Doubova, Svetlana V.; Ranilla, Jesús Medina; Mazzoni, Agustina; Espinoza, Laura; Calderón, Renzo; Arsenault, Catherine; García-Elorrio, Ezequiel; and García, Patricia J., "Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries" (2024). GW Authored Works. Paper 3904.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3904

Department

Global Health