ArticleBMJ open2025
Did health reform improve financial protection for disadvantaged groups in Ecuador? A socio-economic inequality assessment of catastrophic health expenditures 2006-2014.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Can health poverty alleviation policies simultaneously mitigate current and future medical-related poverty? Evidence from four waves (2011-2018) of the China health and retirement longitudinal study (CHARLS).Archives of public health = Archives belges de sante publique · 2025Article
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4 authors.
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Abstract
objectivesLatin American countries have long struggled with socioeconomic inequalities and health equity. In 2007, Ecuador implemented a health reform to address these issues by making public health services free, coordinating finances between subsystems and increasing the state's health budget. This study evaluates whether Ecuador's health system reform (2007-2017) reduced out-of-pocket (OOP) health spending, catastrophic health spending (CHS) and socioeconomic inequalities in CHS.
designCross-sectional study.
settingSecondary data available of households from the 2006 and 2014 National Living Standards Measurement surveys.
methodsDescriptive statistics (means and medians) and log-binomial regression were applied to assess prevalence of OOP and socioeconomic inequalities (residence, region, health insurance status and wealth) in catastrophic health expenditure (CHE) for each period and over time.
resultsOverall, there was a significant reduction of 14% points in the proportion of households with OOP healthcare expenditure. The prevalence of CHE decreased from 17% to 10% and within each socioeconomic group over time. Significant reductions in relative risk were observed in all socioeconomic variables. The inequality in CHE decreased significantly in households placed in rural areas (relative difference (RD): 0.88; 95% CI: 0.79 to 0.97) and poorest (RD: 0.82; 95% CI: 0.69 to 0.97); however, it increased within regions (RD: 0.58; 95% CI: 0.44 to 0.76) and for uninsured households (RD: 1.39; 95% CI: 0.95 to 2.04).
conclusionsThis study suggests that recent health reform effectively reduced OOP healthcare expenditure, CHE and some socioeconomic inequalities. Future reforms should further invest in key areas, expand health insurance for the most disadvantaged and monitor progress towards universal health coverage to address persistent inequalities.
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