Socioeconomic inequalities in health care utilization in Paraguay: Description of trends from 1999 to 2018

Abstract

Objective Paraguay’s health care system is characterized by segmented provision and low public spending, with limited coverage and asymmetries in terms of access and quality of care. The present study provides national estimates of income-related inequality in health care utilization and trends in the country over the past two decades. Methods Using data from the Paraguayan Permanent Household Survey, we estimated socioeconomic inequality in health care use during the period 1999–2018. We used poverty-to-income ratio as the socioeconomic stratifier and defined health care use as having reported a health problem and subsequent health care use in the last 90 days before interview. Inequality was summarized by rank- and level-based versions of the Concentration Index for binary outcomes. Results Inequalities affecting those with lower incomes were present in all years assessed, although the magnitude of these inequalities declined over time. Inequality as expressed by the rank-based index decreased from 0.209 (95%CI 0.164; 0.253) in 1999 to 0.032 (95%CI -0.010; 0.075) in 2018. The level-based index decreased from 0.076 (95%CI -0.029; 0.182) in 1999 to 0.024 (0.002; 0.045) in 2018. Trends in both indices were generally stable from 1999 to 2009, with a noticeable decrease in 2010. The sharpest decreases relative to the 1999 baseline were observed in the period 2010–2018, reflecting changes in health care use and income distribution. Stratification by area, sex and older people suggest similar trends within subgroups. Conclusions Decreases in inequality coincide temporally with increments in public health expenditure, removal of user fees in public health care facilities and the expansion of conditional cash-transfer programmes. Future research should disentangle the role of each of these policies in explaining the trends described.

Socioeconomic inequalities in the use of medical consultation services in Peru, 2019

“…According to the analysis of inequalities, the utilization of a medical consultation was concentrated among the wealthiest individuals. These results are similar to those reported in studies conducted in Chile [ 14 ], Uruguay [ 13 ], Kenya [ 42 ], Italy [ 35 ], China [ 11 ] and Paraguay [ 38 ], where the use of health services was concentrated among people with greater economic resources. The findings are aligned with the hypothesis that wealth has a directly proportional relationship with access to timely and quality health services for individuals, resulting in better long-term health outcomes [ 43 , 44 ].…”

“…The prevalence of health services utilization reported in this study (25%) is lower than that reported in studies conducted in Italy (28%) [ 35 ], Brazil (95.3%) [ 36 ], Jamaica (62.9%), Mexico (64.7%), Panama (58.1%) [ 37 ], Paraguay (66.5%) [ 38 ] and Argentina (40.6%) [ 39 ]. These differences between the figures of the countries and our findings could be attributed to the time horizon for measuring the utilization of medical consultations, since most studies are based on the utilization of medical consultations in the last 12 weeks.…”

Food Insecurity, telomere length and the potential modifying effects of social support in National Health and Nutrition Examination Survey

“…Ideally, there would be more cycles with TL measures to improve sample size and power, particularly given the reduced sample size from NHANES' age restriction of social support questions. Further, the prevalence of food insecurity and social support have changed over time (47,48) . However, we do not believe this would alter the relationship observed between food insecurity and social support.…”