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Dissertation/Thesis Abstract

Incremental health system reform policy in Ecuador: Assessing the impact Ecuador's Law for Provision of Free Maternity and Child Health Care (LMGAI) has on health services utilization, infant health outcomes and expenditures
by Ruiz Chiriboga, Sonia Elizabeth, Ph.D., The Johns Hopkins University, 2008, 222; 3309815
Abstract (Summary)

This primary aim of this study is to assess the impact that the Law for the Provision of Free Maternity and Child Health Care (LMGAI) in Ecuador has had on health services utilization, infant health outcomes and out-of-pocket expenditures. In addition, health service utilization, infant health outcomes and financial outcomes were examined by socio-economic status variables: race/ethnicity, wealth, education and employment. The study is a retrospective study using two cross-sectional Demographic and Health Surveys, ENDEMAIN (Encuesta Demografica y de Salud Materna e Infantil/Demographic and Maternal and Child Health Survey) 1999 & 2004.

Multivariate logistic regression was used to assess impact post-LMGAI implementation and financing, controlling for mother's socioeconomic status, maternal and birth history, and demographic characteristics. Health services utilization outcomes such as prenatal care, having a skilled birth attendant at labor and delivery, and currently using family planning methods significantly improved post-LMGAI. Infant health outcomes had mixed results. Premature births and low birth weight increased post-LMGAI, but neonatal mortality was found to have decreased. Financing and implementation of the LMGAI resulted in variations among outcomes. Women who accessed prenatal, labor and delivery care were still incurring out-of-pocket expenditures, regardless of where they received care. The degree of implementation was seen to have an impact on health services utilization, infant health outcomes and out-of-pocket expenditures, but results were mixed. Expenditure greater than twenty dollars among identified beneficiaries was seen to be significantly less as degree of implementation increased.

Further evaluation of the LMGAI is needed as more data on utilization, infant health outcomes and expenditures is collected. Additional years of data of the ENDEMAIN will be very beneficial to have a long term evaluation of the impact of the LMGAI. A qualitative study to supplement quantitative data would be useful to understand the experience of women accessing services covered under the LMGAI and studies to evaluate other services provided by the LMGAI.

Indexing (document details)
Advisor: Shi, Leiyu
School: The Johns Hopkins University
School Location: United States -- Maryland
Source: DAI-B 69/04, Dissertation Abstracts International
Subjects: Public health, Health care management
Keywords: Ecuador, Expenditures, Health services utilization, Health system reform, Infant health, Law for Provision of Free Maternity and Child Health Care
Publication Number: 3309815
ISBN: 978-0-549-57842-0
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