Johan P. Mackenbach (
Yannan Hu is a postdoctoral fellow in the Department of Public Health, Erasmus University Medical Center.
Health Aff (Millwood). 2017 Jun 1;36(6):1110-1118. doi: 10.1377/hlthaff.2016.1674.
Little is known about the effectiveness of health care in reducing inequalities in health. We assessed trends in inequalities in mortality from conditions amenable to health care in seventeen European countries in the period 1980-2010 and used models that included country fixed effects to study the determinants of these trends. Our findings show remarkable declines over the study period in amenable mortality among people with a low level of education. We also found stable absolute inequalities in amenable mortality over time between people with low and high levels of education, but widening relative inequalities. Higher health care expenditure was associated with lower mortality from amenable causes, but not from nonamenable causes. The effect of health care expenditure on amenable mortality was equally strong, in relative terms, among people with low levels of education and those with high levels. As a result, higher health care expenditure was associated with a narrowing of absolute inequalities in amenable mortality. Our findings suggest that in the European context, more generous health care funding provides some protection against inequalities in amenable mortality.
对于医疗保健在减少健康不平等方面的有效性，我们知之甚少。我们评估了 1980 年至 2010 年间 17 个欧洲国家可通过医疗保健改善的疾病死亡率方面的不平等趋势，并采用了包含国家固定效应的模型来研究这些趋势的决定因素。研究结果表明，在研究期间，教育程度较低的人群中可通过医疗保健改善的死亡率显著下降。我们还发现，在教育程度较低和较高的人群之间，可通过医疗保健改善的死亡率的绝对不平等在时间上保持稳定，但相对不平等在扩大。较高的医疗保健支出与可通过医疗保健改善的死因死亡率降低有关，但与不可通过医疗保健改善的死因死亡率无关。从相对意义上讲，在教育程度较低和较高的人群中，医疗保健支出对可通过医疗保健改善的死亡率的影响同样强烈。因此，较高的医疗保健支出与可通过医疗保健改善的死亡率的绝对不平等的缩小有关。我们的研究结果表明，在欧洲背景下，更慷慨的医疗保健资金为可通过医疗保健改善的死亡率的不平等提供了一定程度的保护。
