<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0124-0064</journal-id>
<journal-title><![CDATA[Revista de Salud Pública]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. salud pública]]></abbrev-journal-title>
<issn>0124-0064</issn>
<publisher>
<publisher-name><![CDATA[Instituto de Salud Publica, Facultad de Medicina - Universidad Nacional de Colombia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0124-00642019000300299</article-id>
<article-id pub-id-type="doi">10.15446/rsap.v21n3.77849</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Aumento de la pobreza e inequidad en el financiamiento del sistema de salud de Ecuador]]></article-title>
<article-title xml:lang="en"><![CDATA[Increase in the poverty and inequity in the funding of the Ecuadorian health system]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Armijos-Briones]]></surname>
<given-names><![CDATA[Marcelo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pires de Sousa]]></surname>
<given-names><![CDATA[Fernando]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zavala-Briones]]></surname>
<given-names><![CDATA[Michelle M.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Regional Autónoma de los Andes Facultad de Ciencias Mé ]]></institution>
<addr-line><![CDATA[Ambato ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidade Federal do Ceará  ]]></institution>
<addr-line><![CDATA[Ceará ]]></addr-line>
<country>Brazil</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital General Santo Domingo  ]]></institution>
<addr-line><![CDATA[Tsachilas ]]></addr-line>
<country>Ecuador</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2019</year>
</pub-date>
<volume>21</volume>
<numero>3</numero>
<fpage>299</fpage>
<lpage>306</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0124-00642019000300299&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0124-00642019000300299&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0124-00642019000300299&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Objetivo El objetivo de este estudio es medir el aumento de la pobreza debido a los gastos directos en salud y analizar la equidad del financiamiento del sistema de salud ecuatoriano, con base en datos de encuestas nacionales representativas del país.  Método Fue realizado con datos de la "Encuesta de condiciones de vida 2013-2014" (ECV) y utilizó líneas de pobreza, con enfoques relativo y absoluto para medir el aumento de la pobreza y, mediante Análisis de Incidencia en el financiamiento, fueron medidas las desigualdades en la distribución del financiamiento.  Resultados La pobreza aumentó 2,2% debido al gasto de las familias en salud, especialmente en gastos de medicamentos y consultas médicas, que representaron 36,7% y 14,6% del gasto total en pagos directos. Además, las fuentes más importantes de financiamiento resultaron ser regresivas, hecho que afecta principalmente a la clase media. Cuando fueron consolidadas, las fuentes de financiamiento analizadas resultaron ser proporcionales. Este, aunque no es el peor escenario, no es el esperado para un sistema de salud que debe garantizar protección financiera a sus usuarios.  Discusión Aunque existen metas de financiamiento de difícil alcance, al menos las leyes del país establecen la búsqueda de ese fin. Sin embargo, pérdidas de recursos financieros dificultan el logro de los objetivos trazados.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Objective The objective of this study is to measure the increase in poverty due to direct health expenditures and to analyze the equity of financing of the Ecuadorian health system, based on data from representative national surveys of the country.  Method It was carried out with data from the 2013-2014 Living Conditions Survey and used poverty lines, with relative and absolute approaches to measure the increase in poverty and, through Analysis of Incidence in Financing, inequalities in the financing distribution.  Results Poverty increased 2.2% due to families spending on health, especially on expenses for medications and medical consultations, which represented 36.7% and 14.6% of total expenditure on direct payments. Furthermore, the most important sources of financing turned out to be regressive, mainly affecting the middle class. When they were consolidated, the sources of financing analyzed turned out to be proportional that, although it is not the worst-case scenario, it is not the expected one for a health system that must guarantee financial protection to its users.  Discussion Although there are financing goals that are difficult to achieve, at least the country's laws establish the pursuit of this goal. However, losses of financial resources make it difficult to achieve the objectives set.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Financiación de la atención de la salud]]></kwd>
<kwd lng="es"><![CDATA[equidad en salud]]></kwd>
<kwd lng="es"><![CDATA[pobreza (fuente]]></kwd>
<kwd lng="es"><![CDATA[DeCS, BIREME)]]></kwd>
<kwd lng="en"><![CDATA[Healthcare financing]]></kwd>
<kwd lng="en"><![CDATA[health equity]]></kwd>
<kwd lng="en"><![CDATA[poverty (source: MeSH, NLM)]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="">
<collab>WHO</collab>
<source><![CDATA[La financiación de los sistemas de salud]]></source>
<year>2010</year>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chokshi]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Income, Poverty, and Health Inequality]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2018</year>
<volume>319</volume>
<numero>13</numero>
<issue>13</issue>
<page-range>1312-3</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="">
<collab>United Nations, CEPAL</collab>
<source><![CDATA[Panorama social de América Latina]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="">
<collab>PAHO</collab>
<source><![CDATA[Financiamiento de la salud en las Américas]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Asante]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Price]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Hayen]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Jan]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wiseman]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses]]></article-title>
<source><![CDATA[PLoS ONE]]></source>
<year>2016</year>
<volume>11</volume>
<numero>4</numero>
<issue>4</issue>
</nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lucio]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Villacrés]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sistema de salud de Ecuador]]></article-title>
<source><![CDATA[Salud Publica Mex]]></source>
<year>2011</year>
<volume>53</volume>
<page-range>s177-87</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<collab>INEC. ECV-INEC</collab>
<source><![CDATA[Instituto Nacional de Estadísticas y Censos; 2015]]></source>
<year>2013</year>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<collab>WHO</collab>
<source><![CDATA[Distribution of health payments and catastrophic expenditures: methodology]]></source>
<year>2004</year>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="">
<collab>INEC</collab>
<source><![CDATA[Metodología de construcción del agregado del consumo y estimación de línea de pobreza en el Ecuador]]></source>
<year>2015</year>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ataguba]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Asante]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Limwattananon]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wiseman]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[How to do (or not to do) ... a health financing incidence analysis]]></article-title>
<source><![CDATA[Health Policy Plan]]></source>
<year>2018</year>
<volume>33</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>436-44</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[O'Donnell]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[van Doorslaer]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Wagstaff]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Lindelow]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<source><![CDATA[Analyzing Health Equity Using Household Survey Data]]></source>
<year>2007</year>
<publisher-name><![CDATA[The World Bank]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mancilla]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Gasto público en salud en el Ecuador]]></article-title>
<source><![CDATA[Rev. Med. FCM-UCSG]]></source>
<year>2012</year>
<volume>18</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>53-60</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="book">
<collab>INEC</collab>
<source><![CDATA[Indicadores pobreza diciembre 2012]]></source>
<year>2012</year>
<publisher-loc><![CDATA[Quito ]]></publisher-loc>
<publisher-name><![CDATA[Instituto Nacional de Estadística y Censos]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wagstaff]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Dmytraczenko]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Almeida]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Buisman]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Hoang-Vu Eoze-nou]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Assessing Latin America's Progress Toward Achieving Universal Health Coverage]]></article-title>
<source><![CDATA[Health Affairs]]></source>
<year>2015</year>
<volume>34</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1704-12</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[López-Cevallos]]></surname>
<given-names><![CDATA[DF]]></given-names>
</name>
<name>
<surname><![CDATA[Chi]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Ortega]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Consideraciones para la transformación del sistema de salud del Ecuador desde una perspectiva de equidad]]></article-title>
<source><![CDATA[Rev Salud Pública (Bogotá).]]></source>
<year>2014</year>
<volume>16</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>346-59</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ortiz-Prado]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Galarza]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Cornejo León]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ponce]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Acceso a medicamentos y situación del mercado farmacéutico en Ecuador]]></article-title>
<source><![CDATA[Rev Panam Salud Pública.]]></source>
<year>2014</year>
<volume>36</volume>
<page-range>57-62</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Malo-Serrano]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Malo-Corral]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reforma de Salud en Ecuador: nunca más el derecho a la salud como un privilegio]]></article-title>
<source><![CDATA[Rev Peru Med Exp Salud Publica]]></source>
<year>2014</year>
<volume>31</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>754-61</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="book">
<collab>El Expreso</collab>
<source><![CDATA[La corrupción vista en dólares]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[Lo Más Importante]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="book">
<collab>El Universo</collab>
<source><![CDATA[Más de $ 35 mil millones se estima perjuicio al país]]></source>
<year>2017</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[El Universo]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="">
<collab>PNUD</collab>
<source><![CDATA[Lucha contra la corrupción por la paz, el desarrollo y la seguridad a nivel mundial]]></source>
<year>2017</year>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="book">
<collab>El Telégrafo</collab>
<source><![CDATA[Remisión de intereses, multas y recargos se aplicará en 6 áreas]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[El Telégrafo]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="book">
<collab>Toka radio</collab>
<source><![CDATA[Lenin Moreno perdonó una deuda a empresarios que supera los 7 mil de dólares]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[Toka Radio]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="book">
<collab>El Comercio</collab>
<source><![CDATA[El Servicio de Rentas Internas condonó USD 32,1 millones en deudas]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[El Comercio]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="book">
<collab>Crisis</collab>
<source><![CDATA[Amnistía tributaria: llegó el turno de los ricos]]></source>
<year>2018</year>
<publisher-loc><![CDATA[Ecuador ]]></publisher-loc>
<publisher-name><![CDATA[Crisis]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
