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Universal Health Coverage in Rural Ecuador: A Cross-sectional Study of Perceived Emergencies
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine.ORCID iD: 0000-0002-3606-1329
Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-4224-1032
Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden.
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2018 (English)In: Western Journal of Emergency Medicine, ISSN 1936-900X, E-ISSN 1936-9018, Vol. 19, no 5, p. 889-900Article in journal (Refereed) Published
Abstract [en]

Introduction: In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies. 

Methods: We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household´s ability to pay.

Results: The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households. 

Conclusion: Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation.

Place, publisher, year, edition, pages
Oakland, CA, United States: University of California , 2018. Vol. 19, no 5, p. 889-900
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-151577DOI: 10.5811/westjem.2018.6.38410PubMedID: 30202504Scopus ID: 2-s2.0-85052319397OAI: oai:DiVA.org:liu-151577DiVA, id: diva2:1250906
Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2018-10-03

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Falk, Magnus

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Eckhardt, MartinFaresjö, TomasFalk, Magnus
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Division of Community MedicineFaculty of Medicine and Health SciencesDepartment of Emergency MedicinePrimary Health Care Center Kärna, Linköping
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