TitleUnderstanding health care utilization : a theoretically-based analysis of the Ecuadorian health care system
Publication TypeThesis
Year of Publication2008
AuthorsLopez-Cevallos, DF
Date Published2008///

One in four Ecuadorians do not have access to health services; while more than two-thirds have no health insurance and insufficient resources to pay for the health care services they might require. The following three studies examined utilization of health care services using Andersen's Health Care Utilization Behavior Theory. Secondary data (in a multilevel multivariate framework) from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN) was the main dataset used. In this context, a better comprehension of people's perceived needs when it comes to utilizing health care services was crucial in determining equity in the provision of services. For such purpose, the first manuscript focused on analyzing various predisposing, enabling and need factors affecting health care utilization in the Ecuadorian population. Adjusting for various predisposing, enabling, and need factors, economic status and ethnicity were significant predictors of health care utilization. Study 2 analyzed the context in which individual health care utilization behavior occurred, focusing on the provision of services and health outcomes. In addition to the main dataset, province-level data from the Ecuadorian System of Social Indicators (SIISE) and the Institute of Statistics and Census (INEC) were included. Spatial autocorrelation scores revealed no significant spatial clustering of provider measures by province, excepting for public practice health personnel. In multilevel models, public practice health personnel was found to be associated with use of preventive care (positively) and antiparasitic medicines (negatively). The density of public inpatient clinics was positively associated with solution of the second reported health problem. Finally, study 3 assessed the relationship between emigrant remittances and health care utilization in Ecuador. Emigrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent to curative visits, even after adjusting for various predisposing, enabling, and need factors. In general, Ecuadorian policymakers need to pay closer attention to inequalities, contextual factors, and the influence of emigrant remittances in advancing health care reform.