Rajmil L, Borrell C, Starfield B, Fernandez E, Serra V, Schiaffino A, Segura A
Institut Universitari de Salut Pública de Catalunya, Campus de Bellvitge, Universitat de Barcelona, Ctra Feixa Llarga s/n, 08907 L'Hospitalet (Barcelona), Catalonia, Spain.
Arch Dis Child. 2000 Sep;83(3):211-4. doi: 10.1136/adc.83.3.211.
To analyse inequalities by social class in children's access to and utilisation of health services in Catalonia (Spain), private health insurance coverage, and certain aspects of the quality of care received.
Cross sectional study using data from the 1994 Catalan Health Interview Survey.
Child population of Catalonia.
A representative sample of non-institutionalised children younger than 15 years (n = 2433).
Health services utilisation, perceived health, type of health insurance (only National Health System (NHS) or both NHS and private health insurance), and social class.
No inequalities by social class were found for the utilisation of health care services provided by the NHS among children in most need. Double health care coverage does not influence the social pattern of visits. Nevertheless, social inequalities still remain in the use of those health services provided only partially by the NHS (dentist) and when characteristics of the last consultation are taken into account. That is, subjects who paid for a private service waited an average of 14.8 minutes less than those whose visit was paid for by the NHS only.
Equitable access and use of medical care services in relation to need, regardless of the type of insurance and social class of their children and families, has been achieved in this region of Spain; differences by social class remain for those services incompletely covered by national health insurance and aspects of the quality of care provided.
分析西班牙加泰罗尼亚地区儿童在获得和使用医疗服务、私人医疗保险覆盖情况以及所接受护理质量的某些方面存在的社会阶层不平等现象。
采用1994年加泰罗尼亚健康访谈调查数据进行横断面研究。
加泰罗尼亚儿童人口。
15岁以下非机构化儿童的代表性样本（n = 2433）。
医疗服务利用情况、自我感知健康状况、医疗保险类型（仅国家卫生系统（NHS）或同时拥有NHS和私人医疗保险）以及社会阶层。
在最需要医疗服务的儿童中，未发现社会阶层对NHS提供的医疗服务利用情况存在不平等现象。双重医疗保险覆盖并不影响就诊的社会模式。然而，在仅部分由NHS提供的医疗服务（牙医服务）使用方面以及考虑最后一次就诊特征时，社会不平等现象仍然存在。也就是说，自费接受私人服务的患者比仅由NHS支付就诊费用的患者平均等待时间少14.8分钟。
在西班牙的这个地区，已实现根据需求公平获得和使用医疗服务，无论其子女和家庭的保险类型及社会阶层如何；在国家医疗保险未完全覆盖的服务以及所提供护理质量的某些方面，社会阶层差异仍然存在。
