Healthcare Trajectories of Adolescent Patients With Cleft Lip and/or Palate According to Health Insurance Coverage in Medellin,Colombia

Abstract

Objective

To describe and compare the healthcare trajectories of patients with CL/P under two different income-based programs for health coverage in Colombia, known in Colombia as a health insurance regime (contributory and subsidized), in Medellín, 2021.

Design

Non-experimental, cross-sectional questionnaire-based study.

Setting

Primary level of clinical care in Medellín, Colombia.

Participants

Twenty-eight 15- to 21-year-olds with CL/P and primary caregivers.

Interventions

Individuals with CL/P answered the survey. Patients with syndromic CL/P and patients with cognitive disabilities were excluded. The calculation of the probabilistic sample was performed based on the formula for finite populations using databases from 2 health insurance companies. The analysis was descriptive and bivariate. Chi-square and Fisher tests were used to analyze the variables of interest.

Main Outcome Measure

Continuity of the care pathway was measured with proxy indicators: (1) access to comprehensive CL/P treatment; (2) timeliness of access to comprehensive CL/P treatment; (3) differences in access to and timeliness of comprehensive CL/P treatment between patients under both health insurance coverage.

Results

No differences were found when comparing the healthcare trajectories of young patients with CL/P who were in both health coverage. Differences were observed in the timeliness of care for patients with CL/P under the subsidized coverage who were more economically vulnerable. Delays in care were mainly linked to administrative procedures required for orthodontic procedures, bone grafts, and maxillofacial surgeries.

Conclusion

Despite the health system's guarantee of equal care across income levels, differences in the timeliness of care persist for patients from lower-income families.