Gundgaard Jens
Institute of Public Health, Health Economics, University of Southern Denmark, Odense.
Scand J Public Health. 2006;34(5):462-71. doi: 10.1080/14034940600554644.
To examine income-related inequity in utilization of healthcare services in Denmark.
A health survey of 2,915 respondents in Funen County interviewed in 2000 and 2001 on health status and socioeconomic and sociodemographic characteristics was merged with various computerized registers including inpatient stays, ambulatory visits, contacts in the primary healthcare sector, and prescription medicine. The index of horizontal inequity was used to estimate the degree of horizontal inequity in utilization of healthcare services across income groups, using the indirect method of standardization to control for age, gender, and self-assessed health as a proxy for need. The standardization method rests on the assumption of equal response behaviour across income groups.
The least advantaged with respect to income consume a bigger share of the health services than the most advantaged with the exception of dental treatments where the opposite is true. After standardization for age, gender, and health status there is no significant inequity in use of all healthcare services. However, when it comes to specific healthcare services the least advantaged have a significantly lower share of the medicine consumption and dental treatments than expected.
The index of horizontal inequity suggests that the Danish healthcare system is in general equitable. In sectors with a high degree of co-payment some horizontal inequity disfavouring the lower income groups appears to be present.
研究丹麦医疗服务利用方面与收入相关的不公平现象。
将2000年和2001年在菲英岛县对2915名受访者进行的关于健康状况、社会经济和社会人口特征的健康调查，与包括住院治疗、门诊就诊、初级医疗部门的接触以及处方药在内的各种计算机化登记数据合并。采用横向不公平指数，使用间接标准化方法控制年龄、性别和自我评估健康状况作为需求的替代指标，来估计不同收入群体在医疗服务利用方面的横向不公平程度。标准化方法基于不同收入群体具有相同反应行为的假设。
在收入方面最弱势群体比最优势群体消费了更大比例的医疗服务，但牙科治疗除外，在牙科治疗方面情况相反。在对年龄、性别和健康状况进行标准化后，所有医疗服务的使用不存在显著不公平现象。然而，在特定医疗服务方面，最弱势群体的药品消费和牙科治疗比例明显低于预期。
横向不公平指数表明丹麦医疗体系总体上是公平的。在共付费用程度较高的部门，似乎存在一些不利于低收入群体的横向不公平现象。
