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AJPH First Look, published online ahead of print Nov 29, 2005
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January 2006, Vol 96, No. 1 | American Journal of Public Health 109-113
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2004.055715

RESEARCH AND PRACTICE

Inequities in Mental Health Care After Health Care System Reform in Chile

Ricardo Araya, PhD, Graciela Rojas, MD, Rosemarie Fritsch, MD, Richard Frank, PhD and Glyn Lewis, PhD

Ricardo Araya and Glyn Lewis are with the Division of Psychiatry, University of Bristol, Bristol, England. Graciela Rojas and Rosemarie Fritsch are with Clinica Psiquiatrica, Facultad de Medicina, Universidad de Chile, Santiago, Chile. Richard Frank is with the Department of Health Care Policy, Harvard University, Cambridge, Mass.

Correspondence: Requests for reprints should be sent to Ricardo Araya, PhD, Division of Psychiatry, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, England (e-mail: r.araya{at}bris.ac.uk).

Objectives. We compared differences in mental health needs and provision of mental health services among residents of Santiago, Chile, with private and public health insurance coverage.

Methods. We conducted a cross-sectional survey of a random sample of adults. Presence of mental disorders and use of health care services were assessed via structured interviews. Individuals were classified as having public, private, or no health insurance coverage.

Results. Among individuals with mental disorders, only 20% (95% confidence interval [CI]=16%, 24%) had consulted a professional about these problems. A clear mismatch was found between need and provision of services. Participants with public insurance coverage exhibited the highest prevalence of mental disorders but the lowest rates of consultation; participants with private coverage exhibited exactly the opposite pattern. After adjustment for age, income, and severity of symptoms, private insurance coverage (odds ratio [OR]=2.72; 95% CI=1.6, 4.6) and higher disability level (OR=1.27, 95% CI=1.1, 1.5) were the only factors associated with increased frequency of mental health consultation.

Conclusions. The health reforms that have encouraged the growth of the private health sector in Chile also have increased risk segmentation within the health system, accentuating inequalities in health care provision.






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