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Equity of access to Chile's priority health services package : overcoming the inverse care law?


Document type: mthesis
Download file(s): 183293 (495 KB)
Abstract: While many low and middle-income countries have implemented a package of priority health services (PHSP), there is little evidence regarding their consequences on equity. Taking the case of Chile, this study aims to analyse equity of utilisation and access to a recently implemented PHSP, the Explicit Health Guarantees Regime (GES). Drawing on Gilson's framework, we examined equity of utilisation using individual and ecological data. Access was addressed as a three-dimensional concept: availability, affordability and acceptability. The study also aimed analysing unintended consequences on services not included in the package. Our results suggest a pro-poor pattern of utilisation at an individual and ecological level. Wealthier beneficiaries have underutilised GES services and opted out the package. Disadvantaged groups have not been significantly empowered, as shown by their lack of information about the package and complaint mechanisms. We found inequities in male utilisation and age exclusions. We observed a significant strengthening of the public sector, expressed in increasing availability of financial resources. However, demand-side aspects have been neglected and uninsured and poorer populations are experiencing a greater burden of out-of-pocket expenses and significant information gaps, respectively. Vaccination coverage and TB control have shown signs of deterioration. Although our results indicate that it is possible to overcome the inverse care law, there is a need to expand the range of benefits of the GES package, introduce demand-side incentives and improve knowledge and complaint mechanisms among disadvantaged groups.
Authors: Peña, S.
Country: Chile
Category: Research
Department: Development Policy & Practice
Institute: KIT (Royal Tropical Institute)
Keywords: health services , policy , empowerment
Language: eng
Organization: KIT - Royal Tropical Institute
PAGE: iv, 65
Year: 2008
Region: South America
Right: © 2008 Fajuri
Subject: Health and Nutrition
Title: Equity of access to Chile's priority health services package : overcoming the inverse care law?
Training: Master in International Health (MIH)