Desigualdad en recursos financieros de la Atención Primaria de Salud Municipal en Chile, 2001-2013 / Inequality of financial resources for primary health care

RESUMEN

Background: The availability of health care resources is one of the main factors influencing health care inequalities. Aim: To evaluate communal inequality in financial resources for municipal primary care in Chile. Material and Methods: The evolution of income, expenditure and investment per subject enrolled was assessed for the period 2001-2013 in the 320 municipalities that administer municipal health. Inequality was evaluated using Lorenz curves and annual indicators (Gini, Theil, Coefficient of Variation and Reason 90/10). For a panel analysis with fixed effects, the association of these resources with socioeconomic variables and municipal health was evaluated. Results: The Gini of per capita spending increased 1.75 times, while the Gini investment grew by 30%. Per capita spending was significantly and inversely associated with poverty, dependency on the Municipal Common Fund, resources coming from the City Hall, spending per capita, expenses in personnel, performance and investment, rate of years of potential life lost and infant mortality. A direct and significant association was observed with global, less than two years and greater than 64 years urban population, destination of municipal revenue to health, per capita investment in health, rate of healthcare professionals, number of attentions and health care centers and availability of primary emergency facilities. Per capita investment was inversely associated with the number of health care centers and directly to the Fund dependency, municipal health coverage and personnel expenses. Conclusions: Inequality in municipal health funds increased substantially and were associated with social vulnerability, access to municipal health and community health outcomes.