Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
Soc Sci Med. 2017 Mar;176:158-165. doi: 10.1016/j.socscimed.2017.01.044. Epub 2017 Jan 24.
International studies have repeatedly shown that people with lower income are more likely to experience difficulties to access medical services. Less is known on why these relations vary across countries. This study investigates whether the association between income and financial barriers to health care is influenced by national public health expenditures (PHE, in % of total health expenditure). Data from the International Social Survey Programme (2011) was used (28 countries, 23,669 respondents). Financial barriers were assessed by the individual experience of forgone care due to financial reasons. Monthly equivalent household income was included as the main predictor. Other individual-level control variables were age, gender, education, subjective health, insurance coverage and place of living. PHE was considered as a macro-level predictor, adjusted for total health expenditure. Statistically significant associations between income and forgone care were found in 21 of 28 examined countries. Multilevel analyses across countries revealed that people with lower income have a higher likelihood to forgo needed medical care (OR: 3.94, 95%-CI: 2.96-5.24). After adjustments for individual-level covariates, this association slightly decreased (OR: 2.94, 95%-CI: 2.16-3.99). PHE did not moderate the relation between income and forgone care. The linkage between health system financing and inequalities in access to health care seems to be more complex than initially assumed, pointing towards further research to explore how PHE affects the redistribution of health resources in different health care systems.
国际研究反复表明，收入较低的人更有可能在获得医疗服务方面遇到困难。对于为什么这些关系在各国之间存在差异，人们知之甚少。本研究调查了收入与医疗保健经济障碍之间的关联是否受到国家公共卫生支出（PHE，占总卫生支出的百分比）的影响。使用了国际社会调查方案（2011 年）的数据（28 个国家，23669 名受访者）。经济障碍通过因经济原因而放弃护理的个人经历来评估。月收入均等家庭收入被包括作为主要预测因素。其他个体层面的控制变量包括年龄、性别、教育、主观健康、保险覆盖范围和居住地点。PHE 被视为一个宏观预测因素，根据总卫生支出进行了调整。在 28 个被检查的国家中，有 21 个国家发现收入与放弃护理之间存在统计学显著关联。国家间的多层次分析表明，收入较低的人更有可能放弃所需的医疗护理（OR：3.94，95%CI：2.96-5.24）。在调整了个体层面的协变量后，这种关联略有下降（OR：2.94，95%CI：2.16-3.99）。PHE 并没有调节收入与放弃护理之间的关系。卫生系统融资与获得医疗保健机会不平等之间的联系似乎比最初假设的更为复杂，这表明需要进一步研究，以探讨 PHE 如何影响不同医疗保健系统中卫生资源的再分配。
