Although antenatal HIV testing has been a standard of care for pregnant Colombian women since 2000, a survey of 10,596 women revealed that only 35 percent of women who received antenatal care between 2000 and 2005 had an HIV test. Of the 10,596 women surveyed, 26 percent had insurance with their employer (contributory), 34 percent had government-subsidized insurance, and 31 percent had no insurance. Eight percent had other forms of insurance.
Subsidized insurance, a healthcare reform measure, was intended to increase access to care for poor people. However, study authors reported that the women with subsidized care were much less likely than women with contributory health insurance or those with no insurance to see a doctor during antenatal visits. The subsidized care group was also 18 percent less likely to receive antenatal HIV testing.
Allison Ettenger, a study author, attributed the lower HIV testing rates among women with subsidized insurance to approval mechanisms and structural barriers built into the subsidized program. For example, women with subsidized insurance were required to travel to the health management organization that enrolled them in the program to give in-person written consent for HIV testing, which presented financial and time challenges. In contrast, women with no insurance did not have this requirement.
Study authors recommended additional research to identify effects of subsidized insurance on access to preventive and primary services and potential means to eliminate structural and approval mechanism barriers.
The full report, “Health Insurance for the Poor Decreases Access to HIV Testing in Antenatal Care: Evidence of an Unintended Effect of Health Insurance Reform in Colombia,” was published online in the journal Health Policy and Planning (2013; doi: 10.1093/heapol/czt021).
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