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Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further s

Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further s

Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further s

Quality health care is an important factor of health status and mortality in each country. The aim of EU cohesion policy is to reduce health care disparities among EU countries. The importance of good health of the population, functioning health systems, and quality health care now has been significantly strengthened in the context of the global Covid-19 pandemic. The main aim of this article is to assess inequalities in unmet healthcare needs and in treatable and preventable mortality in EU-27 countries for different groups of inhabitants by gender, age, education, and income amount. Graphical methods of descriptive statistics and methods of multidimensional comparison using synthetic variable have been used based on the most up-to-date available data for 2018 and 2019 year. In the future, it will certainly be interesting to compare the results obtained in this article with the results of analogous analyses based on data from the pandemic and the post-pandemic period caused by COVID-19 disease., Kvalitní zdravotní péče je důležitým faktorem stavu zdraví a úmrtnosti v každé zemi. Cílem kohezní politiky EU je snižovat rozdíly v péči o zdraví mezi zeměmi EU. Význam dobrého zdraví populace, fungující zdravotní systémy a kvalitní zdravotní péče jsou nyní výrazně posíleny v kontextu celosvětové pandemie Covid-19. Hlavním cílem tohoto článku je posoudit nerovnosti v nenaplněných zdravotních potřebách a v léčitelné a preventivní úmrtnosti v zemích EU-27 u různých skupin obyvatel podle pohlaví, věku, vzdělání a výše příjmu. Byly použity grafické metody deskriptivní statistiky a metody vícerozměrného porovnávání pomocí syntetické proměnné na základě nejaktuálnějších dostupných dat za rok 2018 a 2019. V budoucnu bude jistě zajímavé porovnat výsledky získané v tomto článku s výsledky analogických analýz založených na datech z pandemie a postpandemického období způsobeného onemocněním COVID-19.

Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further s

Background: Limited research is available about the impact of healthcare reforms on healthcare utilization accord‑ing to socioeconomic group. Although most health reforms in Latin America have focused on reducing the gapbetween the most advantaged and disadvantaged groups and improving the quality of health services, the available information has shown limited progress. Therefore, this study assessed whether the recent Ecuadorian healthcare reform (2007–2017) contributed to decreasing the socioeconomic inequalities in healthcare utilization. Methods: We used data from the National Living Standards Measurement surveys conducted in 2006 and 2014. Unmet healthcare needs (UHCN) were used as the dependent variable and proxy for difculties in accessing health services. Place of residence, ethnicity, education and wealth were selected as indicators of socioeconomic status. The slope and relative inequality indexes were calculated for adult men and women for each period and socioeconomic variable. A multiplicative interaction term between midpoint scores and time was applied to estimate changes ininequalities over time. Sample weights were applied to all analyses, and 95% confdence intervals were calculated to assess statistical signifcance in the regression analysis. Results: In 2006, the poor, Indigenous, those living in rural areas and with low education had lower access to health services. In 2014, the overall prevalence of UHCN decreased from 27 to 18% and was higher in women than men. Statistically signifcant reductions of refraining were observed in absolute and relative terms in all social groups, both in men and women. Conclusions: Our results showed remarkable and signifcant decreases in inequalities in all examined socioeconomic groups in absolute and relative terms in this period. Although a new model of healthcare was established to achieve universal health coverage, its performance must be continuously evaluated and monitored with specifc indicators. Further s

Immigrants have 18% lower risk of reporting unmet healthcare needs compared to non-immigrants which can be explained by the “healthy immigrant effect”, whereby the health of immigrants is better at the time of arrival and gradually deteriorates and converges with the Canadian-born population. People with high unmet healthcare needs are higher utilizers of health services. There was no information on how (and if) unmet healthcare needs predict health service utilization and its impact on life satisfaction among immigrant populations and if the relationship varies by length of stay in Canada. The study objectives were to: 1) estimate and compare reported unmet healthcare needs by immigration status. 2) estimate and compare reasons for reported unmet healthcare needs by immigration status; 3) examine relationship between unmet healthcare needs and health service utilization by immigration status. 4) examine relationship between unmet healthcare needs and life satisfaction by immigration status. 5) determine if there is a significant association between health service utilization and life satisfaction by immigration status, controlling for unmet healthcare needs. This was a secondary analysis of cross-sectional data from the Canadian Community Health Survey, cycle 2014 master data file. Individuals who were 18 years of age and older at the time of survey were included and divided into three groups based upon their years of residence in Canada: 1) recent immigrants (≤ 5 years); 2) Long-term immigrants (>5 years); and 3) Canadian-born population. Results indicated that Canadian-born population reported a significantly higher proportion of unmet healthcare needs followed by recent-immigrants and long-term immigrants. “Cost” was the most commonly reported reason for unmet healthcare need among recent immigrants and third most common among long-term immigrants and non-immigrants. Individuals with unmet healthcare needs were more likely to use physician services and reported

Immigrants have 18% lower risk of reporting unmet healthcare needs compared to non-immigrants which can be explained by the “healthy immigrant effect”, whereby the health of immigrants is better at the time of arrival and gradually deteriorates and converges with the Canadian-born population. People with high unmet healthcare needs are higher utilizers of health services. There was no information on how (and if) unmet healthcare needs predict health service utilization and its impact on life satisfaction among immigrant populations and if the relationship varies by length of stay in Canada. The study objectives were to: 1) estimate and compare reported unmet healthcare needs by immigration status. 2) estimate and compare reasons for reported unmet healthcare needs by immigration status; 3) examine relationship between unmet healthcare needs and health service utilization by immigration status. 4) examine relationship between unmet healthcare needs and life satisfaction by immigration status. 5) determine if there is a significant association between health service utilization and life satisfaction by immigration status, controlling for unmet healthcare needs. This was a secondary analysis of cross-sectional data from the Canadian Community Health Survey, cycle 2014 master data file. Individuals who were 18 years of age and older at the time of survey were included and divided into three groups based upon their years of residence in Canada: 1) recent immigrants (≤ 5 years); 2) Long-term immigrants (>5 years); and 3) Canadian-born population. Results indicated that Canadian-born population reported a significantly higher proportion of unmet healthcare needs followed by recent-immigrants and long-term immigrants. “Cost” was the most commonly reported reason for unmet healthcare need among recent immigrants and third most common among long-term immigrants and non-immigrants. Individuals with unmet healthcare needs were more likely to use physician services and reported

Socioeconomic status (SES) differences in health are well known. Both material and psychosocial hypotheses regarding these SES differences have been forwarded. Social capital (trust, social participation) may be seen as a contextual and social extension of this debate with access to healthcare as one of the four hypothesized mechanisms between high social capital and health. This thesis investigates material, psychosocial and social capital factors and SES with regard to unmet health care needs, choice of primary care (PC) provider and mortality in ecological and individual level studies. In paper I, social capital (measured as trust), relative income (Gini index) and absolute income (GNP/capita) were examined in models regarding infant mortality rate (IMR), adult mortality rate (25-64 years) and life expectancy (LE), analyzed in models for all countries (23), and 11 rich and 12 poor separately. Social capital contributed little to the information content (adjusted R2) of the models for all health outcomes, while Gini index had a high information content for IMR in rich countries and BNP/capita for LE in all countries. This suggests that material factors rather than social capital affect health outcomes in this ecological study.In paper II, socioeconomic differences regarding unmet healthcare needs were investigated using the Public Health Survey in Skåne, 2012, including 28,029 respondents aged 18-80. SES was significantly associated with unmet healthcare needs. There was a clear gradient for unmet healthcare needs among the SES groups, where higher non-manual employees had lower levels of unmet healthcare needs than all other employed groups. Only retired persons had lower unmet healthcare needs than the higher non-manual employees. The unemployed, those on long-term sick leave and unskilled manual workers reported particularly high levels of unmet needs. The SES differences in unmet needs were attenuated when economic stress, trust and self-rated health were intr

Conversation and discourse analyses were used to examine medical problem presentation in pediatric care.Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children’s communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are interactionally achieved. We found that medical problem presentation is designed to contain a ‘pre-visit’ account of the interactional and epistemic work that children and caregivers carry out at home to identify the child’s health problems; and that the intersubjective accessibility of children’s experiences that becomes disrupted by ASD presents a dilemma to all participants in the visit. The article examines interactional roots of unmet healthcare needs and foregone medical care of people with ASD.

Conversation and discourse analyses were used to examine medical problem presentation in pediatric care.Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children’s communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are interactionally achieved. We found that medical problem presentation is designed to contain a ‘pre-visit’ account of the interactional and epistemic work that children and caregivers carry out at home to identify the child’s health problems; and that the intersubjective accessibility of children’s experiences that becomes disrupted by ASD presents a dilemma to all participants in the visit. The article examines interactional roots of unmet healthcare needs and foregone medical care of people with ASD.

There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries. © 2014 The Authors.