Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia's constitutional commitment.

Autor: Shepard DS; The Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America., Boada A; School of Government, Universidad de los Andes, Bogotá, Colombia., Newball-Ramirez D; School of Government, Universidad de los Andes, Bogotá, Colombia., Sombrio AG; The Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America., Rincon Perez CW; School of Government, Universidad de los Andes, Bogotá, Colombia., Agarwal-Harding P; The Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America., Jason JS; The Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America., Harker Roa A; School of Government, Universidad de los Andes, Bogotá, Colombia., Bowser DM; The Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Mar 28; Vol. 18 (3), pp. e0282786. Date of Electronic Publication: 2023 Mar 28 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0282786
Abstrakt: Objective: Colombia hosts 1.8 million displaced Venezuelans, the second highest number of displaced persons globally. Colombia's constitution entitles all residents, including migrants, to life-saving health care, but actual performance data are rare. This study assessed Colombia's COVID-era achievements.
Methods: We compared utilization of comprehensive (primarily consultations) and safety-net (primarily hospitalization) services, COVID-19 case rates, and mortality between Colombian citizens and Venezuelans in Colombia across 60 municipalities (local governments). We employed ratios, log transformations, correlations, and regressions using national databases for population, health services, disease surveillance, and deaths. We analyzed March through November 2020 (during COVID-19) and the corresponding months in 2019 (pre-COVID-19).
Results: Compared to Venezuelans, Colombians used vastly more comprehensive services than Venezuelans (608% more consultations), in part due to their 25-fold higher enrollment rates in contributory insurance. For safety-net services, however, the gap in utilization was smaller and narrowed. From 2019 to 2020, Colombians' hospitalization rate per person declined by 37% compared to Venezuelans' 24%. In 2020, Colombians had only moderately (55%) more hospitalizations per person than Venezuelans. In 2020, rates by municipality between Colombians and Venezuelans were positively correlated for consultations (r = 0.28, p = 0.04) but uncorrelated for hospitalizations (r = 0.10, p = 0.46). From 2019 to 2020, Colombians' age-adjusted mortality rate rose by 26% while Venezuelans' rate fell by 11%, strengthening Venezuelans' mortality advantage to 14.5-fold.
Conclusions: The contrasting patterns between comprehensive and safety net services suggest that the complementary systems behaved independently. Venezuelans' lower 2019 mortality rate likely reflects the healthy migrant effect (selective migration) and Colombia's safety net healthcare system providing Venezuelans with reasonable access to life-saving treatment. However, in 2020, Venezuelans still faced large gaps in utilization of comprehensive services. Colombia's 2021 authorization of 10-year residence to most Venezuelans is encouraging, but additional policy changes are recommended to further integrate Venezuelans into the Colombian health care system.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Shepard et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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