Social inequalities in healthcare utilization during Ecuadorian healthcare reform (2007–2017) : a before-and-after cross-sectional study

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