Title : Determinants of access to health care services among adults in Santo Domingo, Dominican Republic
Abstract:
Background: The social determinants of health (SDH) significantly influence population well-being and health equity. In Latin America, social inequalities remain a major barrier to achieving universal health coverage, particularly among vulnerable populations. In the Dominican Republic, although health system coverage has expanded, access to health services remains substantially limited. Understanding the interaction between sociodemographic characteristics and the rising burden of non-communicable diseases is essential for targeted interventions. This study aims to identify the primary determinants of access to health care services among adults in Santo Domingo.
Methods: A secondary analysis was conducted using data from the 2024 Provincial Health Survey (ENPASA), implemented by the Ministry of Public Health and the Pontificia Universidad Catolica Madre y Maestra. The study included adults (≥18 years) residing in Santo Domingo. Health service utilization was defined as the primary outcome. Descriptive statistics were used to characterize the sample across sociodemographic and clinical factors, such as educational attainment, employment status, insurance coverage, and chronic disease prevalence, and bivariate associations between them were assessed using chi-square tests in SPSS version 19, with statistical significance set at p<0.05.
Results: Health care service utilization differed significantly by sex, with higher rates observed among women than men (7.4% vs. 3.1%, p=0.01). When examining marital status, widowed (17.0%) and divorced/separated (17.6%) individuals exhibited the highest utilization rates (p<0.01). Chronic conditions were strong predictors of service use, with individuals with hypertension utilizing services at a significantly higher rate than those without (11.7% vs. 4.1%, p<0.01), while diabetes mellitus showed the most robust association (25.0% vs. 3.9%, p<0.01). Conversely, no statistically significant associations were observed between service utilization and age, educational attainment, insurance type, geographic location of care, or the presence of asthma, tuberculosis, or arthritis.
Conclusion: Health care service utilization is primarily driven by clinical need, particularly diabetes and hypertension, rather than socioeconomic factors or insurance status. Observed disparities by sex and marital status indicate the need for targeted health programs. Strategies should focus on strengthening chronic disease management and addressing health care disparities that limit access to care.
Keywords: Chronic Disease, Dominican Republic, Healthcare Disparities, Health Services Accessibility, Socioeconomic Factors, Social Determinants of Health
