Background
Historical context of the ecuadorian health system
Variable | 2006 | 2014 |
---|---|---|
Total expenditure on health as a percentage of GDP | 5.86 | 9.16 |
Government expenditure on health as a percentage of total expenditure on health | 24.31 | 49.21 |
Government expenditure on health as a percentage of total government expenditure | 5.07 | 10.23 |
Social security expenditure on health as a percentage of government expenditure on health | 23.41 | 50.24 |
Out of Pocket expenditure per capita in US$ | 116.5 | 230.3 |
Total number of Health care Facilities | 3681 | 4139 |
MPH Facilities | 1737 | 2099 |
IESS Facilities | 51 | 74 |
Rural IESS Facilities | 577 | 657 |
Ratio of Doctors (per 1000 population) | 0.903 | 2.035 |
Ratio of Nurses (per 1000 population) | 0.537 | 1.014 |
Under 5 mortality rate | 28.3 | 21.5 |
Adult mortality rate | 144 | 119 |
Prevalence of obesity among adults | 14.6 | 18.3 |
Data and methodology
Measures
Dependent variables | Description |
---|---|
Health status | |
Self-reported illness or accident | Categorical: In the past month, did you have an injury or illness that required medical attention? 1: Yes, 0: No |
Health care utilization | |
Any curative visit | Categorical: Due to the illness or injury, did you visit a doctor, nurse or “curandero”? 1: Yes, 0: No |
Public facility visit | Categorical: Where did you go for a doctor visit the last time you required it? Public, Private. IESS and MPH are categorized as public doctor visits |
Socioeconomic status | Description |
Income | Adult equivalent per-capita income in constant US dollars. Includes labor income, income from capital gains, transfers, pensions, and other alimonies |
Need control variables | Description |
Age | Categorical. Five categories: 18–34, 35–44, 45–64, 65–74, 75- years. |
Sex | Categorical. Reported in the survey: Male, Female |
Restricted activity days | Numeric count: How many days did you stop doing your normal activities due to health problems? Number of days |
Chronic condition | Categorical: Did your illness last over a year? 1: Yes, 0: No |
Non-need control variables | Description |
Education | Continuous. Years of schooling. |
Employment status | Categorical. Employment status. Four categories: Employed, Underemployed, Unemployed, Economically inactive |
IESS affiliation | Categorical: Are you affiliated or covered by any type of IESS (general, voluntary, rural, ISSFA o ISSPOL)? 1: Yes, 0: No |
Marital status | Categorical: Reported in the survey. Married or civil union, Other (single, widow, separated, divorced) |
Region | Categorical: Geographic region of the country. Three categories: Coastal Region; Highlands, Amazon |
Rural | Categorical. 1: Yes, 0: No (Urban) |
Indigenous | Categorical. Self-reported in the survey 1: Yes (Indigenous), 0: No (Other) |
Household size | Number of people living in the household unit |
Data analysis
Results
2006 | 2014 | |||
---|---|---|---|---|
Dependent variables | ||||
Health status | ||||
Self-reported illness or accident | 0.55 | (0.005) | 0.48 | (0.005) |
Health care utilization | ||||
Any curative visit | 0.39 | (0.005) | 0.49 | (0.006) |
Public facility visit | 0.40 | (0.009) | 0.62 | (0.006) |
Socioeconomic status | ||||
Income | 345.77 | (10.144) | 426.72 | (9.319) |
Need control variables | ||||
Age | ||||
18–34 | 0.44 | (0.004) | 0.41 | (0.004) |
35–44 | 0.20 | (0.003) | 0.20 | (0.002) |
45–64 | 0.25 | (0.003) | 0.27 | (0.003) |
65–74 | 0.06 | (0.002) | 0.07 | (0.002) |
75 - | 0.05 | (0.002) | 0.05 | (0.001) |
Sex | 0.48 | (0.002) | 0.48 | (0.002) |
Restricted activity days | 7.79 | (0.169) | 7.37 | (0.160) |
Chronic condition | 0.21 | (0.008) | 0.29 | (0.009) |
Non-need control variables | ||||
Education | 8.37 | (0.092) | 9.16 | (0.077) |
Employment status | ||||
Employed | 0.58 | (0.005) | 0.51 | (0.003) |
Underemployed | 0.17 | (0.004) | 0.21 | (0.004) |
Unemployed | 0.03 | (0.001) | 0.03 | (0.001) |
Economically inactive | 0.22 | (0.003) | 0.25 | (0.003) |
IESS affiliation | 0.21 | (0.006) | 0.39 | (0.005) |
Marital status | 0.64 | (0.004) | 0.62 | (0.004) |
Region | ||||
Coastal region | 0.46 | (0.013) | 0.50 | (0.007) |
Highlands region | 0.50 | (0.014) | 0.46 | (0.006) |
Amazon region | 0.04 | (0.001) | 0.04 | (0.001) |
Rural | 0.34 | (0.013) | 0.31 | (0.009) |
Indigenous | 0.07 | (0.006) | 0.07 | (0.003) |
Household size | 4.72 | (0.035) | 4.25 | (0.021) |
Sample size | 32,469 | 66,418 |
Standardized quintile distributions of health and health care utilization variables
Year | Mean | Q1 | Q2 | Q3 | Q4 | Q5 | |
---|---|---|---|---|---|---|---|
Health status | |||||||
Self-reported Illness | 2006 | 0.55 | 0.60 | 0.59 | 0.57 | 0.55 | 0.49 |
2014 | 0.48 | 0.51 | 0.52 | 0.50 | 0.47 | 0.44 | |
Dif | −0.07* | −0.09* | −0.07* | −0.07* | −0.08* | −0.05* | |
Health care utilization | |||||||
Any curative visit | 2006 | 0.37 | 0.25 | 0.35 | 0.35 | 0.38 | 0.53 |
2014 | 0.48 | 0.39 | 0.44 | 0.49 | 0.51 | 0.56 | |
Dif | 0.11* | 0.14* | 0.09* | 0.14* | 0.13* | 0.03* | |
Public facility visit | 2006 | 0.41 | 0.49 | 0.48 | 0.44 | 0.37 | 0.29 |
2014 | 0.63 | 0.76 | 0.74 | 0.66 | 0.59 | 0.51 | |
Dif | 0.22* | 0.27* | 0.26* | 0.22* | 0.22* | 0.22* |
Concentration indices and horizontal inequity indices for health status and health care utilization variables
Variable | 2006 | 2014 | Dif. 2014–2006 | |||
---|---|---|---|---|---|---|
CI | HII | CI | HII | CI | HII | |
Self-reported illness | −0.056* | − 0.043* | −0.065* | − 0.047* | −0.009* | − 0.004 |
Any curative visit | 0.058 * | 0.066 * | 0.015 * | 0.023 * | −0.043 * | −0.043 * |
Public facility visit | −0.102 * | −0.100 * | − 0.084 * | −0.083 * | 0.018 * | 0.017 * |