Access to ambulatory health care according to type of health insurance and income in Chile, 2009

Introduction: Given the structure of the Chilean Healthcare System, Chileans can be sorted at least into four distinct groups: publicly insured/low-income, publicly insured/middle-income, privately insured/middle-income and privately insured/high-income. Hypotheses: (1) middle class privately insured groups will have worse access to preventive services than privately insured high income and all other publicly insured groups regardless of income after controlling for all other relevant variables because of higher co-pays and a scantly regulated delivery system (2) a higher income and being privately insured significantly predicts better access to specialty visits. Methods: Using the CASEN 2009 database, fixed and random effects models were used controlling for clustering at the municipality level. Results: There was no significant difference in access to health check-ups between low-income publicly insured individuals and middle-income privately insured individuals. Being privately insured was associated with a higher probability of having a pap smear in the last three years compared to low and middle-income publicly insured groups. Specialty visits showed the predicted relationship between income/insurance groups and utilization. Conclusion: The results for access to a pap smear did not support our hypothesis however in terms of health check-ups at least, low-income groups get the same access as middle income privately insured groups, a fact that can be explained by some features of the Chilean public healthcare delivery system. A better set of measures of preventive care would be needed to explore differential access to these services in the Chilean Health System.