This article examines socio-economic determinants and inequality of health care utilization in Ecuador. Despite health reform efforts in Latin America, drastic socio-economic inequalities persist across the region, including Ecuador. Almost a third of Ecuador's population lack regular access to health services, while more than two-thirds have no health insurance and insufficient resources to pay for health care services. Using Andersen's model of health care utilization behaviour, relevant variables were selected from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN) household survey. Four outcomes were assessed: use of preventive services, number of curative visits, hospitalization, and use of antiparasitic medicines. Adjusting for various predisposing, enabling and need factors, a significant negative relationship was found between household economic status (as measured by assets and consumption quintiles) and utilization of preventive and curative services. The same was true for use of antiparasitic medicines. Further, indigenous ethnicity was found to be a significant negative predictor of health care utilization, regardless of economic status. These socio-economic inequalities in the use of health care services suggest the need for health care reform in Ecuador to address these issues more systematically. It is necessary for public health authorities to move forward on a reform that will expand coverage, particularly to indigenous and low- and middle-income households

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18–25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services.