title: Migration, remittances, and health care utilization in Ecuador.
abstract: OBJECTIVE
  To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects.
  
  
  METHODS
  Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status.
  
  
  RESULTS
  Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services.
  
  
  CONCLUSIONS
  Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.
authors.affiliation: Western Oregon University, Monmouth, Oregon, United States of America. lopezced@wou.edu
authors.forename: Daniel F
authors.initials: DF
authors.lastname: López-Cevallos
authors.forename: Chunhuei
authors.initials: C
authors.lastname: Chi
mesh_terms: D000328:Adult; D000977:Antiparasitic Agents / Q000627:therapeutic use; D003625:Data Collection; D004363:Drug Utilization / Q000706:statistics & numerical data; D004467:Economics / Q000706:statistics & numerical data; D004484:Ecuador; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005006:Ethnicity; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000977:Antiparasitic Agents