Inequalities in access to healthcare for people with disabilities in Chile: the limits of universal health coverage

We analysed cross-sectional data collected as part of the National Socioeconomic Characterisation Survey (2013) in Chile, in order to explore if there are differences in access to healthcare between adult Chileans with and without disability. The study included 7,459 Chilean adults with disability and 68,695 people without disability. Logistic regressions were performed in order to determine the adjusted odds ratios for the associated variables. We found that despite universal health coverage, Chileans with disabilities are more likely to report worse access to healthcare, even when controlling for socioeconomic and demographic variables, including age, gender, and income. Specifically, they are more likely to face greater difficulty arriving at a health facility, obtaining a doctor’s appointment, being attended to in a health facility, paying for treatment due to cost, and obtaining necessary medicine. Both people with and without disability are more likely to face difficulties in accessing health services if they are affiliated with the public health provider, an indication of the economic factors at play in accessing healthcare. This study shows that universal health coverage does not always lead to accessibility of health services and underlines the disadvantaged position of disabled people in Chile in accessing health services. While efforts have been made recently to improve equity in healthcare access, disability in Chile poses an additional burden on people’s access to healthcare, emphasising the necessity for policy to address this perpetual cycle of disadvantage for disabled people

Depressive symptoms in people with disabilities; secondary analysis of cross-sectional data from the United Kingdom and Greece

Background: Evidence suggests there is an association between depressive symptoms and disability. Objective/Hypothesis: The objective of this study was to examine whether people with disabilities in the United Kingdom and Greece face more depressive symptoms than people without disabilities. The hypothesis was that people with disabilities in both countries are more likely to experience depressive symptoms. Methods: We used data from the 2014 European Health Interview Survey (wave 2). After performing principal-component factor analysis, we carried out logistic regressions, in order to investigate differences in depressive symptoms between people with and without disabilities, and examine the factors affecting depressive symptoms for people with disabilities. Results: People with disabilities in the UK were 2.8 times more likely to experience depressive symptoms compared to people without disabilities (95% C.I.: 2.51-3.05, p < 0.001), while in Greece, they were 2.2 times more likely to do so (95% C.I.: 1.90-2.64, p < 0.001). Our findings regarding people with disabilities showed that women, older people (in Greece), unemployed and inactive people (in Greece), and better-educated people (in the UK) were more likely to experience depressive symptoms. Married people, older people (in the UK), people living in densely-populated areas (in Greece), people who assessed their health as ‘average’ or ‘good’, and people who enjoyed social support (in Greece) were less likely to face depressive symptoms. Conclusions: Due to population-ageing and higher incidence of depressive symptoms in disabled people, it is important that policies are put in place to address the mental health needs of this population

Access to health care for men and women with disabilities in the UK: a secondary analysis of cross-sectional data

Objectives: The aim of this study was to investigate differences in access to health care between people with and without disabilities in the UK. The hypotheses were that: a) people with disabilities would be more likely to have unmet health care needs; and b) there would be gender differences, with women more likely to report unmet needs. Setting and Participants: We performed secondary analysis, using logistic regressions, of de-identified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 12,840 community-dwelling people over the age of 16 from across the UK, 5,236 of whom had a disability. The survey method involved face-to-face and telephone interviews. Outcome measures: Unmet need for health care due to long waiting lists, or distance or transportation problems; not being able to afford medical examination, treatment, mental health care, or prescribed medicines. All measures were self-reported. Results: Adjusting for age, sex, and other factors, people with a severe disability had higher odds of facing unmet needs. The largest gap was in ‘unmet need for mental health care due to cost’, where people with a severe disability were 4.5 times (CI 95%: 2.2-9.2) more likely to face a problem, as well as in ‘unmet need due to cost of prescribed medicine’, where people with a mild disability had 3.6 (CI 95%: 2.2-5.9) higher odds of facing a difficulty. Women with a disability were 7.2 times (CI 95%: 2.7-19.4) more likely to have unmet needs due to cost of care or medication, compared to men with no disability. Conclusions: People with disabilities reported worse access to health care, with transportation, cost, and long waiting lists being the main barriers. These findings are worrying as they illustrate that a section of the population, who may have higher health care needs, faces increased barriers in accessing services

Utilisation of mammography by women with mobility impairment in the UK: secondary analysis of cross-sectional data

Objectives Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation. Sample and design We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews. Outcome measures Self-report of the last time a mammogram was undertaken. Results Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile. Conclusions In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others

Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile

The aim of this article is to discuss how neoliberal policies implemented in the Chilean health system during the Pinochet regime have a lingering effect on equal access to health care today. The two-tier health system – public and private – that was introduced in the early 1980s as a means to improve efficiency and lower healthrelated costs, has led instead to inequality of access and dehumanisation of health care. Health has changed from being a right to being a marketable need, thus creating a structural disadvantage for several parts of the population – particularly the poor, the elderly, and women – who cannot afford the better-quality services and timely attention of private health providers, and thus, are not adequately protected against health risks. Despite the recent health reforms that aim at improving equity in health care access and financing, we argue that the Chilean health system is still biased against the poorer segments of the population, while it favours the more affluent groups that can afford private health care

Access to health care in an age of austerity: disabled people’s unmet needs in Greece

Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5,400 community-dwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socioeconomic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces

Determinants of utilisation rates of preventive health services: Evidence from Chile

Background: Preventive health services play a vital role in population health. However, access to such services is not always equitably distributed. In this article, we examine the barriers affecting utilisation rates of preventive health services, using Chile as a case study. Methods: We performed secondary analysis on cross-sectional data of more than 200,000 Chilean adults, taken from the 2015 National Socioeconomic Characterisation Survey of the Government of Chile. We carried out logistic regressions to explore the relationship between the dependent variable use of preventive services and various demographic and socioeconomic variables. Results: The results of the logistic regressions show that women, the elderly, married people, inactive people, and people with average or good self-assessed health score had higher odds of using preventive health services. Women, for example, had 1.2 times (CI 95%: 1.11-1.21) higher odds of using preventive services than men On the other hand, people living in rural areas, single people, and people affiliated with the private health care provider had fewer odds of undertaking such exams. People living in rural areas, for example, had 1.1 times (CI 95%: .86-.95) fewer odds of undertaking preventive exams than people living in urban areas. Conclusions: The findings underline the necessity of better information campaigns on the availability and necessity of preventive health services, addressing health inequality in accessing health services, and tackling lifestyle-related health risks. This is particularly important in countries – such as Chile – that are characterised by high income inequality and low utilisation rates of preventive health services

Disability inclusiveness of government responses to COVID-19 in South America: a framework analysis study

Background: Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. Methods: We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures not designed specifically for disabled people). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the World Health Organisation and other international organisations. Results: We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most vulnerable to COVID-19, disabled people living in institutional care, were the ones who were left the most exposed to the risks, in several cases protected only by recommendations rather by legislation. Conclusions: This study illustrates how the official government responses taken by four countries in the region – while positive, in several aspects – do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID -19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase

Structural disadvantage and (un)successful ageing: gender differences in activities of daily living for older people in Chile

Discourses on successful ageing have changed the way older age is viewed and the possibilities associated with it. However, such discourses do not always take into account differential capacities and resources that may shape disadvantage for women. The aim of this article is to examine gender differences in the experience of difficulties carrying out basic and instrumental activities of daily living (ADLs) in community-living people over the age of 65, using Chile as a case study. We also examine the effect of healthcare provider on performance of ADLs. We carried out logistic regressions on cross-sectional data from a sample of over 33,000 men and women, drawn from the 2015 National Socioeconomic Characterisation Survey, conducted by the Ministry of Social Development of the Government of Chile. We found significant gender differences in experiences of performing ADLs for older people in Chile, with women consistently reporting more problems than men. The affiliation with the public health provider was also associated with gender differences. The results of our study indicate that women in Chile experience structural disadvantage in their efforts to age successfully, reporting higher levels of functional limitations. We argue that it is important that gender-sensitive public health initiatives be developed, focusing on the prevention of functional disability