Identifying local barriers to access to healthcare services in Chile using a communitarian approach

Abstract

Introduction Previous research has used proxy variables or a unique construct to quantify healthcare access. However, there is a need for a different model that can handle this multivariable problem. This study seeks to develop a way to measure access to the local healthcare system with higher local resolution. Methods A new survey was developed based on communitarian claims, following a behavioural model and an ontological framework. The survey was used to identify local barriers to healthcare services and the local preferences for priority settings. The results were analysed using multiattribute utility functions and individual weights were assigned by a panel of experts. National and regional indexes of access to healthcare were developed. Results The survey contained seven modules and 104 questions. It was conducted on 1885 participants at 42 rural and 231 urban locations in three regions of Chile. The total disutility of the identified barriers to healthcare access at the national level was low (0.1448; values ranged between 0 and 1, with 1 representing a higher barrier) and was higher in the northern region (0.1467). The barriers associated with the health‐policy component showed the highest disutility value, and specific barriers for each community were identified. Conclusions These results have the potential to improve health decision‐making in Chile and can be used to assess the impacts of new health policy reforms. Although this model was tested in Chile, it can be adapted for use in any other country. Patient or Public Contribution Participants contributed to this study by completing a survey, participating in general talks and receiving brochures with the results obtained from this study.

La importancia de las Barreras de acceso y equidad en la atención de los servicios de salud

“…Con respecto a detallar las barreras de acceso predominantes en las diversas sociedades y demostrar las deficiencias en la equidad, voy a detallar los siguientes hallazgos. En Chile, Núñez (2022), demostró los diferentes tipos de "barreras de acceso" encontrados en su país, que impidieron la accesibilidad a servicios de salud. Estas barreras de acceso identificadas a nivel nacional tuvieron un índice bajo siendo estas barreras asociadas al componente de política de salud las que presentaron el mayor valor de impacto negativo a nivel nacional y regional (>0,83).…”

“…Con respecto a "Satisfacción del consumidor" se halló elevada cobertura de seguro de salud (0,18) y lenguaje poco claro usado por el médico (0,15). Finalmente, en las "Características de la población en riesgo", se encontró el bajo nivel de reembolso en medicamentos (0,26) (Núñez & Manzano, 2022).…”

“…Si bien, desde entonces existió una mejora global sin precedentes en los indicadores de salud, el 50% de la población mundial sigue sin tener acceso a los servicios de salud esenciales (Ihantamalala et al, 2020). El bajo acceso a la atención médica en entornos rurales mundialmente, mayormente en países en desarrollo se debe a una combinación de barreras financieras, geográficas y del sistema de salud (Núñez & Manzano, 2022). Para reducir el impacto de los sistemas de salud débiles y los costos de los usuarios en el acceso a la atención médica, existe un consenso sobre la importancia central del fortalecimiento del sistema de salud y la cobertura universal de salud (Garnelo et al, 2020).…”

From sharing voices to making decisions: The case for centring community ownership in evaluation of health programme planning and management

“…48 In the last decade Chile has focussed on enhancing the active role of users in health management, involving them in consultative processes (such as in the development of the Health Objectives for the decade), and planning and evaluation processes (for example, participatory budgeting for health services). 49,50 Experiences of participatory work have been documented in case studies about citizen participation and co-management for health in Chile 51 and other peer-reviewed publications 34,52 :…”

“…In the last decade Chile has focussed on enhancing the active role of users in health management, involving them in consultative processes (such as in the development of the Health Objectives for the decade), and planning and evaluation processes (for example, participatory budgeting for health services) 49,50 . Experiences of participatory work have been documented in case studies about citizen participation and co‐management for health in Chile 51 and other peer‐reviewed publications 34,52 : The Adelaida in Biobío experience, which features empowered formal citizen councils, organised at local and provincial levels of the health system, capable of leveraging intersectoral and private sector resources for action on social determinants of health affecting people with disabilities. A primary health centre (CESFAM), Madre Teresa de Calcuta, was established in the Santiago metropolitan region, which addressed challenges in developing a citizen participation plan with community representatives in a neighbourhood with little social cohesion, weak public infrastructure and disperse community resources. In Santiago Sano, an adolescent committee of student leaders organised in 10 municipal high schools, which have decision‐making control in development and publication of a sexuality manual. Psircutopia, an initiative in a deprived neighbourhood of the northern city of Ovalle, engaged socially vulnerable youth in performance art, aiming to expand their self‐esteem and capacities to express needs and connect with available services. Another Santiago CESFAM, Juan Pablo II, developed a receptive environment for exercise of health rights by immigrants, through culturally appropriate information and support for inclusion in local health councils, public accounts, and citizen dialogs. Grupo Llareta, an autonomous community‐led work, generating resources and supportive networks over 30 years in a historically mobilised neighbourhood of Santiago, independent of government organisations. A population survey administrated in three regions of Chile that identified healthcare access barriers and explored an alternative method to solicit community preferences for priority setting. …”