La reforma en salud del Ecuador

Espinosa, Verónica; Acuña, Cecilia; Torre, Daniel de la; Tambini, Gina

doi:10.26633/rpsp.2017.96

Cited by 25 publications

(42 citation statements)

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“…Respecto al personal sanitario, progresivamente se ha ido mejorando la densidad de recursos humanos, especialmente de médicos y enfermeras de tal forma que el Ecuador según la OPS alcanzó la meta de los desafíos de Toronto que para el 2015 se debía tener 25 profesionales de la salud por 10.000 habitantes 14 . Se pasó de 11 201 a 33 644 profesionales entre los años 2008 y 2015 5 , situación que reflejaría una continuidad de la política de incrementar los recursos humanos en el Ministerio de Salud, en este periodo.…”

Section: Recursos Humanosunclassified

“…En este nuevo marco legal, se reconoce que el Estado garantiza el derecho a la salud, que se vincula con el ejercicio de otros derechos como acceso al agua, alimentación, nutrición, educación, cultura física, trabajo, seguridad social, ambientes sanos y otros que sustenten el buen vivir. [4][5][6] El cumplimiento de estos derechos es responsabilidad del Estado a través de políticas económicas, sociales, culturales, educativas y ambientales, así como el acceso permanente a programas, acciones y servicios de promoción y atención integral de salud, salud sexual y reproductiva. [4][5][6][7] Los cambios generados por la nueva Constitución en la salud pública y el acceso a atención de salud en el Ecuador han sido escasamente evaluados y documentados.…”

Section: Introductionunclassified

“…[4][5][6] El cumplimiento de estos derechos es responsabilidad del Estado a través de políticas económicas, sociales, culturales, educativas y ambientales, así como el acceso permanente a programas, acciones y servicios de promoción y atención integral de salud, salud sexual y reproductiva. [4][5][6][7] Los cambios generados por la nueva Constitución en la salud pública y el acceso a atención de salud en el Ecuador han sido escasamente evaluados y documentados. Por esta razón, el objetivo de este artículo es examinar la experiencia del Ecuador en la reforma de su sistema de salud analizando algunas de las áreas que han sufrido cambios como partes de este proceso.…”

Section: Introductionunclassified

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Análisis del Sistema de Salud del Ecuador

2019

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ResumenIntroducción: Ecuador inició una reforma en su sistema de salud en el año 2008; sin embargo, los cambios generados por la nueva Constitución de la República, en la salud pública y el acceso a atención de salud en el Ecuador, han sido escasamente evaluados y documentados. Objetivo: examinar la experiencia del Ecuador en la reforma de su sistema de salud analizando algunas de las áreas que han sufrido cambios como parte de este proceso. Metodología: se realizó investigación de tipo descriptivo, observacional. Se recuperó artículos relevantes de bases de datos que incluyó PubMed, Cochrane, ScienceDirect y UpToDate, se consultó sitios web gubernamentales y de organizaciones relacionadas con la salud como el Banco Mundial, Organización Mundial de la Salud, Organización Panamericana de la Salud, Unión de Naciones Suramericanas, entre otras. Resultados: se destaca en este periodo la decisión política de centralizar la planificación y gestión de salud a nivel del gobierno central. Se incrementa el número de consultas de morbilidad pero sin incremento de las de prevención. Las enfermedades crónicas ocupan los primeros lugares como causa de muerte. La mortalidad materna se mantiene alta y no alcanza la meta propuesta por el país. Hay importante incremento del presupuesto en salud, pero este no refleja protección financiera de los pacientes ya que el gasto de bolsillo está cerca del 50%. Conclusión: el sistema de salud del Ecuador no logra aún alcanzar plenamente objetivos sanitarios que impacten en la mejora de la calidad de la atención de la salud. También persisten barreras de acceso a atención integral y oportuna; y, limitada protección financiera. Se requiere consolidar sistemas de información que permitan acceso a información completa y oportuna.PALABRAS CLAVE: Sistema de Salud, políticas públicas de salud, salud pública, sistemas de información en salud.Abstract Introduction: Ecuador initiated a reform in its health system in 2008; however, changes in public health and access to health care in Ecuador generated by the new Constitution have been poorly evaluated and documented. Objective: To examine reform of Ecuadorian health system by analyzing some of the areas that have undergone changes as part of this process. Design: Observational descriptive research. Relevant articles were retrieved from databases that included PubMed, Cochra-ne, ScienceDirect and UpToDate; government websites and organizations related to health such as the World Bank, World Health Organization, Pan American Health Organization, Union of South American Nations, among others were consulted. Results: The political decision to centralize health planning and management at the central government level was highlighted during this period. Morbidity is increased but there is no increase in prevention. Chronic diseases occupy first places as a cause of death. Maternal mortality remains high and does not reach the goal proposed by the country. There is significant increase in the health budget, but this does not reflect the financial protection ...

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Section: Recursos Humanosunclassified

Section: Introductionunclassified

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Análisis del Sistema de Salud del Ecuador

2019

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“…Overall, few studies have assessed the impact of the Ecuadorian health care reform on the population's health. The literature has been mainly descriptive and focused on achievements in terms of coverage [19,22]. A recent study has reported signi cant reductions in income inequalities in health care utilisation [23], however, no study has paid attention to the potential impact of the reform on different socioeconomic groups or speci c health care outcomes.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform succeeded?

Quizhpe

Sebastián

Terán

et al. 2020

Preprint

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Background: Over the last twelve years, Ecuador has implemented a comprehensive health sector reform to ensure equitable access to health care services according to health needs. While there have been important achievements in terms of health care coverage, the effects of these reforms on socioeconomic inequalities in health care have not been analysed. This study assessed whether the health care reform implemented in the 2007 - 2017 decade contributed to reducing the socioeconomic inequalities in women´s health care access.Methods: This study was based on two waves of the Living Standards Measurement Survey conducted in Ecuador in 2006 and 2014. Data from women of reproductive age (15 to 49 years) was analysed to evaluate health care coverage in three indicators: skilled birth attendance, cervical cancer screening and the use of modern contraceptives. Absolute risk differences were calculated between the heath care indicators and the socioeconomic variables using binomial regression analysis for each time period. The Slope Index of Inequality (SII) was also calculated for each socioeconomic variable and period. A multiplicative interaction term between the socioeconomic variables and period was included to assess the changes in socioeconomic inequalities in health care over time.Results: Access to health care increased in the three studied outcomes during the health sector reform. Significant inequality reductions in skilled birth attendance were observed in all socioeconomic variables except in the occupational class. Cervical cancer screening inequalities increased according to education and occupation, but decreased by wealth. Only a decrease by education was observed for modern contraceptive use. Conclusions: While most socioeconomic inequalities in skilled birth attendance decreased during the reform, this was not the case for inequalities in cervical cancer screening or the use of modern contraceptives. Further work is needed to address the social determinants of these health inequalities.

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“…Therefore, it becomes crucial to manage the inclusion of new health technologies under an evidence‐based perspective, whilst keeping in mind the permanent constraints on the availability of financial resources . Since the implementation of a new Constitution in 2008, Ecuador has experienced substantial changes related to the provision of medical care as an effort to move towards universal access to health . Therefore, the expansion of cancer services, including essential cancer drugs, free of charge to all, has been the rule since 2008.…”

Section: Introductionmentioning

confidence: 99%

Policies influencing access to new targeted oncologic drugs in Ecuadorian hospitals: an interrupted time series analysis

Durán

Elseviers

Stichele

et al. 2019

J Pharm Health Serv Res

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Objective and methods An interrupted time series analysis was performed to measure the impact of two policy interventions on the accessibility to new targeted oncologic drugs in Ecuador. The first intervention decentralized the selection process allowing drug and therapeutic committees (DTCs) to directly select new drugs. The second brought back the final decision to a central body but kept the first decision level in hospitals. Five-year (2010Five-year ( -2014 individual dispensing data from the six largest Ecuadorian cancer hospitals were analysed. Monthly incidence rate of targeted oncologic drug users (per 1000 cancer patients) was defined as the unit of analysis. Level and slope changes after policy interventions were studied; P value <0.05 was considered statistically significant. Key findings In public hospitals, incidence rate immediately dropped (level) after the first policy intervention (P < 0.05). The slope increased not significantly until the second policy. After the second intervention, the incidence level dropped, and the slope was negative (both not significant). In private hospitals, the incidence level dropped significantly after the first policy, followed by a significant slope increase. After the second intervention, the incidence level dropped, and the slope was negative (both significant). Conclusions Transferring to DTCs the responsibility to select new drugs produced an increase in prescription intensity of targeted oncologic drugs, mainly in the private sector. The second intervention changed this trend. Combination of different levels of decision, meaning a DTC analysis plus a reanalysis by a central body, seems to limit new prescriptions of targeted oncologic drugs.

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La reforma en salud del Ecuador

Cited by 25 publications

References 0 publications

Análisis del Sistema de Salud del Ecuador

Análisis del Sistema de Salud del Ecuador

Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform succeeded?

Policies influencing access to new targeted oncologic drugs in Ecuadorian hospitals: an interrupted time series analysis

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