Barriers to Access to Health Care: The Role of Health Literacy, Political Trust and the Bureaucracy

• Published in: The Latin Americanist (Orlando, Fla.) Fla.), 2012-03, Vol.56 (1), p.107-126
• Main Authors: Horan, Jennifer E., Livsey, Kae R.
• Format: Article
• Language: English
• Subjects: Academic Achievement; Access; Bureaucracy; Health Care Services; Literacy; Peru; Public Health; Reform; Trust
• ISSN: 1557-2021; 1557-203X
• DOI: 10.1111/j.1557-203X.2012.01145.x

In 2006 The World Bank published the results of two years of evaluation of Peru's public health and education sectors (Cotlear 2006). In the executive summary, the editor noted that Peru needed "a change of culture to shock the system out of the low level equilibrium in which it finds itself" (Cotlear 2006). The public health problems confronting the Peruvian people are daunting. The government acknowledges the problem, and has been working over the past decade to implement necessary reform to increase health care access for the most vulnerable sectors of the Peruvian population. This paper examines the impact of health sector reforms in an urban squatter community outside Arequipa, Peru, and provides a local level view of the challenges confronting the government as it works to improve overall access to healthcare. Using data from the 2005 Latinobarometer, and original survey data collected in Peru in May of 2009 and 2010, we argue that three factors are interacting to limit access to the health care system, and therefore, hinder the achievement of significant improvement in public health. These factors are: limited health literacy, low trust in government and a confusing bureaucratic structure. Adapted from the source document