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.

multilevel analysis Health services accessibility Migration National health policy Ecuador Emigration and immigration, trends

information processing migrants remittance Ecuador hospitalization economics poverty human immigration Antiparasitic Agents middle aged statistics antiparasitic agent Ethnic Groups rural population health service ethnic group family size Family Characteristics Health Services Needs and Demand Young Adult drug utilization health care cost Humans male female Socioeconomic Factors Health Expenditures Multivariate Analysis socioeconomics health services Health Status Indicators Article adult migration Utilization Review Emigration and Immigration Health Policy ethnicity population migration Data Collection health survey