A Primary Care System to Improve Health Care Efficiency: Lessons from Ecuador

Abstract

Ecuador is a country with few resources to spend on health care. Historically, Ecuador has struggled to find a model for health care that is efficient, effective, and available to all people in the country, even those in underserved and rural communities. In 2000, the Ecuador Ministry of Public Health implemented a new system of health care that used primary care as its platform. Since then, Ecuador has been able to increase its health care efficiency, increasing its ranking from 111 of 211 countries worldwide in 2000, to 20 of 211 countries in 2014. This article briefly reviews the new components of the system implemented in Ecuador and examines the tools used to accomplish this. The discussion also compares and contrasts the Ecuador and US systems, and identifies concepts and policies from Ecuador that could improve the US system. (J Am Board Fam Med 2017;30:380 -383.)

Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades

“…This coincides with the emergence of Ecuador's major public health reform, which promises free health care and focuses on primary care, prevention, and family planning. 12,14 Since then, whereas cesarean deliveries in public centers have not decreased, the risk of cesarean deliveries in private centers and social security institutions has increased.…”

“…11 Furthermore, throughout this time, Ecuador's health care system has been fragmented into three separate segments: the public sector, which provides free services for all; the social security sector (including the Instituto Ecuatoriano de Seguridad Social and the Seguro Social Campesino), which serves all working-class families through a tax paid by employers; and the private sector, which is expensive and thus serves the wealthiest individuals. 12 The majority of private sector patients pay out of pocket, as only 3% of Ecuador's population is covered by private health insurance. 13 Over the past three decades, Ecuador's health care system has transitioned from primarily private to increasingly public.…”

“…13 Since 2000, the Ministry of Health has increased spending, and in 2008, Ecuador passed legislation guaranteeing free health care to all with a focus on primary care, prevention, and family planning. 12,14 The influx of funding to the public health sector since then has been used to build and fortify general and specialty clinics throughout Ecuador, with the number of free clinics and health care professionals based on regional populations. 12 However, despite increased budgets, public institutions have had difficulty keeping up with the patient demand that has arisen through free health care reform.…”

“…12,14 The influx of funding to the public health sector since then has been used to build and fortify general and specialty clinics throughout Ecuador, with the number of free clinics and health care professionals based on regional populations. 12 However, despite increased budgets, public institutions have had difficulty keeping up with the patient demand that has arisen through free health care reform. Meanwhile, the private sector, which includes for-profit institutions like hospitals and clinics as well as nonprofit organizations, continues to account for 15% of health care facilities in Ecuador, drawing medical staff from public institutions through higher salaries and maintaining patients through the promise of high-quality and efficient care.…”

Research on Clinical Decisions Made Daily in Family Medicine

“…For example, by expanding primary care, Ecuador dramatically increased its international ranking for health care efficiency from 111th to 20th among 121 countries worldwide. 16 We wish that the United States understood the importance of primary care in reducing health care costs. In another article, Kao …”