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Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey.

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dc.contributor.author Ramos Rosas, Eduardo
dc.contributor.author Winkler, Volker
dc.contributor.author Huicho Oriundo, Luis
dc.contributor.author Blas Blas, Magaly Marlitz
dc.contributor.author Brenner, Stephan
dc.contributor.author De Allegri, Manuela
dc.coverage.spatial Perú
dc.date.accessioned 2023-12-05T17:47:58Z
dc.date.available 2023-12-05T17:47:58Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14618
dc.description.abstract BACKGROUND: The government-subsidized health insurance scheme Seguro Integral de Salud ("SIS") was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal - "PEAS" (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages. METHODS: Relying on the 2021 round of the nationally-representative survey "ENDES" (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15-49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum. RESULTS: Only 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the "SIS" group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14-1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17-1.48), ANC education (aOR = 1.59; 95% CI 1.41-1.80) and ANC screening (aOR = 1.46; 95% CI 1.27-1.69) during pregnancy, compared with women in the "Standard Insurance" group [aOR = 1.35 (95% CI 1.13-1.62), 1.22 (95% CI 1.04-1.42), 1.34 (95% CI 1.18-1.51) and 1.31(95% CI 1.15-1.49)] respectively. In addition, women in the "Standard Insurance" group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33-3.55) compared with the women in the "SIS" insurance group (aOR = 2.12; 95% CI 1.41-3.17). CONCLUSIONS: Our findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under "Standard Insurance" or "SIS". Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries BMC Pregnancy and Childbirth
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Health insurance en_US
dc.subject Peru en_US
dc.subject Maternal healthcare en_US
dc.subject SIS en_US
dc.subject Seguro Integral de Salud en_US
dc.subject Women’s health en_US
dc.subject Inequities en_US
dc.subject Comprehensive en_US
dc.subject Health Insurance en_US
dc.subject.mesh Seguro de Salud Basado en Valor
dc.subject.mesh Perú
dc.subject.mesh Bienestar Materno
dc.subject.mesh Salud de la Mujer
dc.subject.mesh Inequidades en Salud
dc.subject.mesh Seguro Médico General
dc.title Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s12884-023-06086-3
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.02
dc.relation.issn 1471-2393


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