Centre for Health Economics, University of the West Indies, Trinidad and Tobago.
Rev Panam Salud Publica. 2013 Feb;33(2):116-21, 3 p preceding 116. doi: 10.1590/s1020-49892013000200006.
This study addresses the need to measure and explain the inequalities and inequities of Jamaica's health system to generate evidence to support policy development, monitoring, and evaluation.
The nationally representative Jamaica Survey of Living Conditions data sets for 2004 and 2007 were used to produce concentration curves and concentration indices for three health outcome variables (probability of any illness or injury, duration of latest episode of -illness, and self-assessed health status) and two health care utilization variables (probability of a curative visit to a health practitioner and number of curative visits) to measure income-related inequalities. Their standardized counterparts were used to measure inequities. Decomposition of the concentration index provides a basis for explaining the contributions of socioeconomic and demographic factors to overall inequalities.
Probability of illness and duration of illness were concentrated among the poor, while there was a distinct pro-rich inequality with respect to utilization of heath care services. These inequalities and inequities became more pronounced over the period 2004 - 2007. The level of household welfare was found to be the single most significant factor contributing to these inequalities. Other significant contributing factors were unemployment and rural location for health outcomes and insurance coverage for utilization of services.
In spite of measures taken ostensibly to address health equity in Jamaica, income-related inequalities in health outcomes and health care have increased and the population group that needs health services most is using them least. These findings suggest a need for more innovative programs geared toward improving equity in health in Jamaica.
本研究旨在衡量和解释牙买加卫生系统的不平等和不公平现象，为政策制定、监测和评估提供证据。
本研究使用了 2004 年和 2007 年具有全国代表性的牙买加生活条件调查数据集，生成了三个健康结果变量（任何疾病或伤害的概率、最近一次疾病发作的持续时间和自我评估的健康状况）和两个卫生保健利用变量（去卫生保健提供者进行治疗性访问的概率和治疗性访问次数）的集中曲线和集中指数，以衡量收入相关的不平等。使用它们的标准化指标来衡量不公平。集中指数的分解为解释社会经济和人口因素对整体不平等的贡献提供了基础。
疾病的发生概率和持续时间集中在贫困人口中，而在卫生保健服务的利用方面，存在明显的有利于富人的不平等现象。这些不平等和不公平现象在 2004 年至 2007 年间变得更加明显。家庭福利水平被发现是导致这些不平等的唯一最重要因素。其他重要的影响因素包括失业和农村地区的健康结果以及保险覆盖范围对服务利用的影响。
尽管牙买加采取了表面上旨在解决卫生公平的措施，但与收入相关的健康结果和卫生保健的不平等现象有所增加，最需要卫生服务的人群利用卫生服务的程度最低。这些发现表明，牙买加需要制定更多创新的方案，以改善卫生公平。
