In BMJ Open, Edy Quizhpe Ordóñez, Miguel San Sebastian, Enrique Teran, and Anni-Maria Pulkki-Brännström present a socio-economic inequality assessment of Ecuador’s health reforms from 2006 to 2014. The study evaluates whether the reforms—which made public health services free, boosted state health budgets, and integrated financing—had an effect on out-of-pocket (OOP) payments, catastrophic health spending (CHE), and related inequalities.
Substantial reforms were made in the Ecuadorian health system starting in 2006. Several strategies were implemented, beginning with the decision to make all existing public health services available free of charge. Additionally, financial resources were mobilised from the national budget, increasing the state’s contribution to overall spending on health. Furthermore, the article explains that the Ecuadorian Social Security Institute witnessed a significant expansion in coverage between 2007 and 2013.
Using nationally representative survey data, the authors found a marked decline in households with OOP health expenditure (down 14%) and a drop in CHE prevalence from 17% to 10%. Rural and poorest households saw the most significant gains, while inequalities persisted or worsened in some regions and among the uninsured. These findings suggest that Ecuador’s reforms improved financial protection for disadvantaged groups. The authors, however, point out the need for targeted measures to close remaining gaps—especially expanding insurance coverage and addressing supply chain inefficiencies to achieve equitable universal health coverage.