Inequalities in the utilization of health services in Chile? Analysis of the effects of individual income and health insurance coverage in timely receipt health care services

The association between individual characteristics and the utilization and timeliness of access of health services in Chile was studied. Both a descriptive and a multivariate analysis were performed to assess the relationship between the different independent variables (age, gender, marital status, education, area of residence, type of health coverage and income quintile) and the dependent variables (actual utilization of health services and opportunity of the use of health services). People older than 65 year, women, people covered by the public social insurance (FONASA) were more likely to suffer difficulties or delays on the use of health services than younger people, men, and beneficiaries of the ISAPRES. Poor people had greater difficulties using health services and using them on time than the rest of the population. Moreover, there is an inverse related sliding scale between household income and frequency of delays and difficulties to receive health services. The results of the polychotomous logistic regression analyses showed several disparities in the use and timeliness of health services. Children had 0.77 times less probabilities of cannot use health services than adults, and elderly 0.59 times less probabilities than adults. Married individuals have better probabilities of use health services in a timely fashion in comparison to never married individuals (OR = 0.85). Better education and living in urban areas were directly related with use of services on time. Those covered by public insurance FONASA have 1.18 times the probabilities of not using health services when they need it in comparison to those covered by private insurances ISAPREs. Family income was strongly associated with the use of health services in a timely fashion, odds ratios that compared lower income quintiles (1st, 2nd, 3rd and 4th) to the highest income quintile are positive (OR = 1.90, 1.59, 1.47 and 1.45), in a sliding scale and all parameters reached statistical significance. The comparison between individuals that use health services late compared to individuals that use it on time also showed several disparities. For instance men were more likely to receive services late than females (OR = 0.91); and Public health insurance was associated with receiving health interventions late, those in FONASA were 2.65 times more probabilities of experimented serious delays in accessing health services than ISAPREs enrollees. Also family income was directly associated with the use of health services on time, individuals from the poorest income quintile are two times more likely to receive health interventions late than richer individuals from the 5th income quintile. However, no statistical differences were found on use of health services late in relation to use it on time among education categories (OR = 1.00 C.I. 0.94–1.06; and OR = 0.94 C.I. 0.91–0.98). The findings also pointed out differences between Chileans in the time they received health interventions. Similar patterns were found for most of the eight types of health services analyzed. These disparities in the use of health services in Chile must be taken into account for the outgoing health reform that is aimed at improving access and eliminating differences among Chileans regarding health care.