Access to health care in Colombia: The effects of income and provider availability on the use of medical services in seven cities

Research objective. The aim of the study was to identify the most important determinants of utilization of medical services in Colombia. The objective was to quantify the impact of the individuals' income versus the medical services' availability on the use of health services. The hypothesis were: (1) Use of health services increases with increasing need for health services. (2) Use of health services increases with increasing income. (3) Use of health services increases with greater availability of providers. (4) Income is a stronger predictor of use of health services than is provider availability, after controlling for need and other socio-demographic characteristics.;Study design. This study used a cross-sectional design with multiple-source data. The data on individual characteristics are from the March 1994 National Household Survey. This survey was applied to 56,000 individuals residing in seven major cities of Colombia (Bogota, Cali, Medellin, Barranquilla, Bucaramanga, Manizales and Pasto). Availability of physicians and hospitals was collected for the study by conducting a census of practicing physicians and medical institutions. Study variables were generated by calculating with a geographical information system the straight-line distance from the individual to the nearest providers, and by measuring the density of providers available to the individual.;Principal findings. Need for health services was a strong determinant of both physician visits and hospitalizations. Use of physician visits increased with increasing percapita family income, use of hospitalization was predicted by income, in a U shaped pattern. The availability of providers had an effect on the use of physician visits, but not on the use of hospitalizations. Income had a stronger effect on the use of physician visits than did provider availability.;Conclusions and policy implications. The results of this study suggest that the best way to improve equitable access to medical services in urban areas is to maintain the demand-based subsidies, while supporting the development of better organized community health centers.