Health inequalities in post-COVID-19 Chile: Health system coverage and effective access by sex and migrant status

In 2022, after the COVID-19 pandemic, approximately 93% of the countries in the Region of the Americas continued to report interruptions in essential health services, with worse outcomes in vulnerable social groups. The present study aims to describe barriers to access to health care in Chile, disaggregated by sex and international migrant status.

Cross-sectional study, analyzing the results of the CASEN 2022 survey of persons ≥18 years of age. We calculated ascription, effective access and health barriers by international migrant status and sex. Multiple logistic regression models were performed adjusting for age, rurality, educational level, occupation, and income quintile. The model was expressed as an adjusted Odds Ratio (ORadj) with a 95% confidence interval in STATA v.18.5.

For the year 2022 in Chile, a total of 14,767,688 people were represented in this study, with a mean age of 45.4 years (SD: 17.8), 51.2% were women and 9.27% were migrants. Regarding health insurance, 3.11% of the population was not affiliated with the health system, with men (ORadj: 0.6; 95% CI: 0.54-0.68) and immigrants (ORadj: 10.3; 8.78-12.15) being the most affected groups. In terms of effective access, 17.4% had health needs, with a predominance of the female sex (ORadj: 1.3; 95% CI: 1.21-1.32). However, of those who had needs and expressed them, 39.2% expressed unmet needs, with a higher probability of showing it in women (ORadj: 1.2; 95% CI: 1.10-1.27).

In Chile, health system coverage remains a challenge for men and the migrant population. We observe with concern high percentages of unmet health needs, particularly among women. The intersection of sex and international migration reveals a dual vulnerability in access to health care that warrants further study.