Bioética y equidad en el acceso a los servicios de salud en Ecuador y América Latina

This study identifies inequality in access to healthcare as a structural problem associated with segmented systems. Its purpose is to analyze, from a bioethical perspective, how such institutional arrangements perpetuate or correct inequalities and what procedural standards can legitimize them. A non-experimental, cross-sectional, exploratory-descriptive design was applied, aligned with PRISMA/PRISMA-S, with searches in Scopus, WoS, SciELO, and Latindex (2020–2025), double verification, and coding of equity dimensions, bioethical frameworks, and results. The findings show “pro-rich” gradients in effective access and perceived quality in several countries; in Ecuador, inequality of use has decreased, but geographical, indirect financial, organizational, and cultural barriers persist, affecting rural, indigenous, and migrant populations. The discussion interprets these asymmetries as violations of distributive justice and highlights the usefulness of “Accountability for Reasonableness” to make prioritization decisions transparent and review them. Operational lines are proposed: redistribution of human talent and supply, strengthening of referral-counterreferral, intercultural mediation, and mitigation of non-medical costs with equity monitoring. In conclusion, converting nominal coverage into equitable access requires combining organizational and financial protection actions with procedural standards that ensure ethical legitimacy and continuous improvement.