Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries.

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

Patient navigation for traumatic brain injury promotes community re-integration and reduces re-hospitalizations.

OBJECTIVE: To determine the effectiveness of a Navigation programme for patients with traumatic brain injury. DESIGN: Prospective programme evaluation. SETTING: Inpatient rehabilitation facility and community settings. PARTICIPANTS: Eighteen individuals who suffered a traumatic brain injury (TBI), were between the ages of 16-70 years, and had a Rancho Score greater than IV. INTERVENTION: Patient navigation programme focused on identifying and addressing barriers to positive outcomes, including coordination of care and facilitating communication among the family and healthcare providers, psychosocial support, caregiver support, adherence to treatment, education, community resources and financial issues. MAIN OUTCOME MEASURES: Functional status, re-hospitalizations, falls, neurobehavioral symptom inventory, neuroendocrine status, activities of daily living, community integration and caregiver burden. RESULTS: There was a significant reduction in re-hospitalization and fall rate when comparing individuals who received navigation services and those who did not. We also observed improved adherence treatment plans and a significant increase in community integration, independence level and functional abilities. CONCLUSIONS: This study begins to highlight the effectiveness of a patient navigation programme for individuals with TBI. Future research with a larger sample will continue to help us refine patient navigation for chronic disabling conditions and determine its sustainability.