Browsing by Author "Paraje, Guillermo"
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Item Changes in Socioeconomic Inequalities in the Use of Dental Care Following Major Healthcare Reform in Chile, 2004–2009(2015) Cornejo-Ovalle, Marco; Paraje, Guillermo; Vásquez Lavín, Felipe; Pérez, Glòria; Palència, Laia; Carme, BorrellItem Desigualdad e inequidad en la utilización de servicios médicos por grupos etarios en Chile, 2000-2011(School of Business and Economics, Universidad del Desarrollo, 2011) Vásquez Lavín, Felipe; Chovar Vera, Alejandra; Paraje, GuillermoEste artículo considera esta heterogeneidad entre la población y examina índices de desigualdad e inequidad en la utilización de servicios médicos para niños, adultos, y adultos mayores en Chile entre el 2000 y 2011Item Desigualdad e inequidad en la utilización de servicios médicos según grupos etarios en Chile, 2000–2011(2014) Vásquez Lavín, Felipe; Paraje, Guillermo; Chovar Vera, AlejandraObjetivo. Calcular los índices de desigualdad e inequidad en la utilización de servicios médicos para menores, adultos y adultos mayores en Chile entre 2000 y 2011. Métodos. Se utiliza la encuesta CASEN (2000–2011) y se calculan el índice de concentración (IC) para medir la desigualdad y el índice de inequidad horizontal (IIH) para medir inequidad en la utilización de servicios médicos. Los grupos de análisis son cuatro: menores de 5 años, menores entre 6 y 18 años, adultos y adultos mayores. Resultados. Los resultados indican que la utilización de servicios de médicos especialistas presenta mayor nivel de desigualdad en los grupos de menores de edad y mayor nivel de inequidad en el grupo de adultos. En la utilización de servicios de atención dental, es el grupo de adultos mayores el de mayor desigualdad e inequidad. Las visitas a servicios de urgencias en los dos últimos años de los cuales se tienen datos (2009 y 2011), presentan mayor nivel de desigualdad en el grupo de adultos. Conclusiones. Existen diferencias en los niveles de inequidad y desigualdad entre menores, adultos y adultos mayores a través de los años al menos en tres de las seis variables en estudio.Item Health Equity in an Unequal Country: The Use of Medical Services in Chile(2012) Paraje, Guillermo; Vásquez Lavín, FelipeIntroduction: A recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper's main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented. Methods: Concentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A "mean effect" (how these indices would change if the differential use in healthcare services were evenly distributed) and a "distribution effect" (how these indices would change with no change in average use) were obtained. Results: Changes in concentration indices were mainly due to mean effects for all cases, except for specialists (where "distribution effect" prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index. Conclusions: The increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e. g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform.Item Income-related inequality in health and health care utilization in Chile, 2000-2009(01/02/2013) Vásquez Lavín, Felipe; Paraje, Guillermo; Estay, ManuelObjective. To measure and explain income-related inequalities in health and health care utilization in the period 2000–2009 in Chile, while assessing variations within the country and determinants of inequalities. Methods. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. Results. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, prorich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. Conclusions. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the use of specialized and dental services, which favor the rich, deserves policy makers’ attention and further investigation related to the quality of these services.Item Inequality and Inequity in the Use of Medical Services in Chile, by Age Group, 2000-2011(2014) Chovar Vera, Alejandra; Vásquez Lavín, Felipe; Paraje, GuillermoObjective. To calculate indices of inequality and inequity in the use of medical services for children, adults, and older adults in Chile from 2000 to 2011. Methods. Based on the CASEN survey (2000-2011), the concentration index (CI) was calculated to measure inequality and the horizontal inequity index (HI) was calculated to measure inequity in the use of medical services. Four groups were studied: children under 5, children aged 6-18 years, adults, and older adults. Results. The results indicate higher levels of inequality in the use of specialized physician services in the child groups, and higher levels of inequity in the adult group. In the use of dental services, the greatest inequality and inequity is found among older adults. For visits to emergency services in the last two years for which data are available (2009 and 2011), the adult group shows a higher level of inequality. Conclusions. In terms of levels of inequity and inequality, there are differences among children, adults, and older adults over the years in at least three of the six variables studied.Item La investigación en salud y la evaluación de tecnologías sanitarias en Chile(Sociedad Médica de Santiago, 2014) Espinoza, Manuel Antonio; Cabieses, Báltica; Paraje, GuillermoHealth research is considered an essential element for the improvement of population health and it has been recommended that a share of the national health budget should be allocated to develop this field. Chile has undertaken efforts in the last decades in order to improve the governmental structure created to promote the development of health research, which has increased human resources and funding opportunities. On the other hand, the sustained economic growth of Chile in the last decades suggests that the health expenditure will maintain its increasing trend in the following years. This additional funding could be used to improve coverage of current activities performed in the health system, but also to address the incorporation of new strategies. More recently, health technology assessment (HTA) has been proposed as a process to support decisions about allocation of resources based on scientific evidence. This paper examines the relationship between the development of health research and the HTA process. First, it presents a brief diagnosis of the situation of health research in Chile. Second, it reviews the conceptual basis and the methods that account for the relationship between a HTA process and the development of health research. In particular, it emphasizes the relevance of identifying information gaps where funding additional research can be considered a good use of public resources. Finally, it discusses the challenges and possible courses of action that Chile could take in order to guarantee the continuous improvement of an articulated structure for health research and HTA.