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The effect of the healthcare system's structure on COVID‐19 dynamics in Ecuador

Author

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  • Grace Carolina Guevara‐Rosero

Abstract

To manage the COVID‐19 pandemic, governments established certain stringency measures, such as lockdowns and traffic light systems. However, the response to the pandemic depended on the regions' preexisting capacities and underlying conditions. This study aims to determine the relationship between the COVID‐19 pandemic dynamics and the underlying regional healthcare system's structure in Ecuador, using three dependent variables—the number of COVID‐19 cases, the COVID‐19 prevalence rate at the cantonal level, and the daily deaths resulting from COVID‐19 at the provincial level—for three phases: isolation, social distancing, and contingency. Using daily COVID‐19 data and cantonal (provincial) level variables, a negative binomial model and a tobit model were estimated to analyze the determinants of the number of COVID‐19 cases and the prevalence rate, respectively. The results show a positive relationship between primary and secondary health centers and the number of infected people, implying that it is possible to make more diagnoses when the health infrastructure is more developed. As for COVID‐19 deaths, primary health centers are associated with a low number of daily deaths whereas secondary health centers are associated with a higher number of daily deaths, implying the transfer of severe COVID‐19 cases to cantons with secondary health centers. More affluent cantons had more COVID‐19 cases and deaths. Stringency measures, such as the traffic light system, were effective in managing the pandemic. The geographical proximity between cantons and the nature of economic activities (essential versus non‐essential) also impacted the spread of the virus. Para gestionar la pandemia de COVID‐19, los gobiernos establecieron ciertas medidas rigurosas, como confinamientos y sistemas semafóricos. Sin embargo, la respuesta a la pandemia dependió de las capacidades preexistentes y de las condiciones subyacentes de las regiones. Este estudio pretende determinar la relación entre la dinámica de la pandemia de COVID‐19 y la estructura del sistema regional de salud subyacente en Ecuador, utilizando tres variables dependientes, que fueron el número de casos de COVID‐19, la tasa de prevalencia de COVID‐19 a nivel cantonal y las muertes diarias resultantes de COVID‐19 a nivel provincial, utilizadas para tres fases: aislamiento, distanciamiento social y contingencia. Se utilizaron datos diarios de COVID‐19 y variables a nivel cantonal (provincial) para estimar un modelo binomial negativo y un modelo Tobit para analizar los determinantes del número de casos de COVID‐19 y la tasa de prevalencia, respectivamente. Los resultados muestran una relación positiva entre los centros de salud primarios y secundarios y el número de personas infectadas, lo que implica que es posible realizar más diagnósticos cuando la infraestructura sanitaria está más desarrollada. En cuanto a las muertes por COVID‐19, los centros de salud primarios se asocian a un número bajo de muertes diarias, mientras que los centros de salud secundarios se asocian a un número mayor de muertes diarias, lo que implica la transferencia de casos graves de COVID‐19 a cantones con centros de salud secundarios. En los cantones más prósperos se registraron más casos y muertes por COVID‐19. Las medidas rigurosas, como el sistema de semáforos, fueron eficaces para gestionar la pandemia. La proximidad geográfica entre cantones y la naturaleza de las actividades económicas (esenciales frente a no esenciales) también influyeron en la propagación del virus. 各国政府は、COVID‐19のパンデミックに対処するため、ロックダウンや信号機システム(信号の色に模した3段階評価)などの厳格な措置を確立した。ところが、パンデミック対応は、地域の既存の能力と根本的な条件に依存していた。本稿では、感染者の隔離(isolation)、ソーシャルディスタンス、不測の事態、以上の3つのフェーズについて、3つの従属変数(COVID‐19の症例数、州レベルでのCOVID‐19の有病率、州レベルでの1日あたりのCOVID‐19による死亡者数)を使用して、エクアドルにおけるCOVID‐19のパンデミックの動態と基礎にある地域医療システムの構造に関連性があるかを検討する。COVID‐19の日別データと州レベルの変数を使用して、負の二項モデルとトービットモデルで推定を行い、それぞれCOVID‐19症例数と有病率の決定要因を分析した。結果から、一次及び二次医療機関と感染者数に正の関連性が示され、現状よりも医療インフラが整備されれば、より多くの診断が可能になることが示唆された。COVID‐19による死亡に関しては、一次医療機関では1日当たりの死亡者数が少なく、二次医療機関では1日当たりの死亡者数が多いことから、COVID‐19の重症症例が二次医療機関のある州に移送されていることが示唆される。裕福な州ほどCOVID‐19の感染者数と死者数が多かった。信号機システムなどの厳格な措置は、パンデミックの管理に効果があった。州と州の地理的な近接性と経済活動の性質(必要不可欠か不要不急か)も、ウイルスの拡散に影響している。

Suggested Citation

  • Grace Carolina Guevara‐Rosero, 2023. "The effect of the healthcare system's structure on COVID‐19 dynamics in Ecuador," Regional Science Policy & Practice, Wiley Blackwell, vol. 15(8), pages 1795-1819, October.
    • Handle: RePEc:bla:rgscpp:v:15:y:2023:i:8:p:1795-1819
    DOI: 10.1111/rsp3.12666
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    References listed on IDEAS

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    1. Andrés Rodríguez‐Pose & Chiara Burlina, 2021. "Institutions and the uneven geography of the first wave of the COVID‐19 pandemic," Journal of Regional Science, Wiley Blackwell, vol. 61(4), pages 728-752, September.
    2. David Bailey & Jennifer Clark & Alessandra Colombelli & Carlo Corradini & Lisa De Propris & Ben Derudder & Ugo Fratesi & Michael Fritsch & John Harrison & Madeleine Hatfield & Tom Kemeny & Dieter F. K, 2020. "Regions in a time of pandemic," Regional Studies, Taylor & Francis Journals, vol. 54(9), pages 1163-1174, September.
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