Faculty of Social Sciences, Hellenic Open University, Patras, Greece.
Int J Equity Health. 2011 Apr 26;10:16. doi: 10.1186/1475-9276-10-16.
Equal utilization of health services for equal need, is one of the main targets for public health systems. Given the public-private structure of the Greek NHS, the main aim of the study was to investigate the impact of underlying factors, such as health care needs, socio-demographic characteristics and ethnicity, on the utilization of primary and hospital health care in an urban and rural population of the Greek region, Thessaly.
A cross-sectional study was carried out in 2006 in Thessaly, a Greek region of Central Greece, in a representative sample of 1372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Health care needs were determined by self-perceived health status estimated by the SF-36 Health Survey, using the summary scores of physical and mental health. The utilization of primary care was measured by last month visits to 1) primary public services and 2) private practitioners visits and utilization of secondary care was measured by past year visits to 3) public hospital emergency departments and 4) admissions to public hospitals. Multivariable stepwise logistic regression analysis was applied in the whole sample and separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value < 0.05.
Health care needs were the most significant determinants of primary and secondary health services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments.
Although health care needs were the main determinant of health services utilization in both the urban and rural population, socio-economic and ethnic differences also seem to contribute to the inequities observed in some types of health services use, favouring the better-off. Such findings provide important information to policy makers, which attempt to reduce inequalities in health care according to place of residence and ethnicity.
公平利用卫生服务以满足平等需求，是公共卫生系统的主要目标之一。鉴于希腊国民保健系统的公私结构，本研究的主要目的是调查医疗保健需求、社会人口特征和种族等基本因素对希腊塞萨利地区城乡人口初级和医院卫生保健利用的影响。
2006 年在希腊中部塞萨利地区进行了一项横断面研究，在一个具有代表性的 1372 名个体（18 岁以上，应答率 91.4%）样本中通过面对面访谈进行。利用 SF-36 健康调查评估的自我感知健康状况确定医疗保健需求，使用身体和心理健康的综合评分。初级保健的利用通过上个月对以下内容的访问来衡量：1）初级公共服务和 2）私人医生就诊；二级保健的利用通过过去一年对以下内容的访问来衡量：3）公立医院急诊部门和 4）公立医院住院治疗。多变量逐步逻辑回归分析应用于整个样本，并分别应用于城市和农村人群，以确定卫生服务利用的预测因素。统计显著性以 p 值<0.05 确定。
医疗保健需求是城乡地区初级和二级卫生服务利用的最重要决定因素。身体和心理健康状况较差与更高的使用可能性相关。在城市地区，中年、老年和希腊人更有可能使用初级保健服务，而接受初等教育与更多的急诊部门就诊相关。较富裕的个体更有可能住院。来自农村地区的具有大学学历的个体更频繁地访问公共初级服务，而较富裕的个体更频繁地访问私人医生。移民更有可能去急诊部门就诊。
尽管医疗保健需求是城乡人群卫生服务利用的主要决定因素，但社会经济和种族差异似乎也导致了一些类型的卫生服务使用不平等，使较富裕的个体受益。这些发现为政策制定者提供了重要信息，他们试图根据居住地和种族减少卫生保健方面的不平等。
