Social determinants of health and their impact on equity in access to healthcare services worldwide

Resumen

This study analyzed how social determinants of health influence equity in healthcare access across Mexico, Colombia, and Ecuador. A total of 3,600 adults participated, representing diverse sociodemographic profiles by age, gender, education, income, and ethnicity. A cross-sectional, comparative design was employed, using a harmonized survey instrument and semi-structured interviews to examine insurance coverage, healthcare utilization, barriers to access, discrimination, and perceptions of equity. Descriptive and inferential analyses showed that uninsured status, low income, limited education, rural residence, and indigenous identity were the strongest predictors of inequitable access. Colombia exhibited higher levels of public insurance coverage, more frequent healthcare utilization, and greater trust in institutions, while Mexico and Ecuador displayed larger uninsured populations, more pronounced economic and geographic barriers, and higher reports of discrimination. Participants in Ecuador reported the poorest self-rated health, whereas Colombia showed the most favorable assessments. Across all three countries, public insurance schemes played a central role in coverage, but systemic barriers such as long waiting times, medicine shortages, and service saturation continued to limit effective access. The findings confirm that inequities in healthcare access are shaped by both structural and cultural determinants, reinforcing the need for policies that extend beyond insurance reform to address poverty, education, ethnicity, and geographic disparities. These results contribute to regional debates on universal health coverage and highlight the importance of designing strategies that strengthen equity in health systems throughout Latin America.