Morteruel Maite, Rodriguez-Alvarez Elena, Martin Unai, Bacigalupe Amaia
Maite Morteruel, PhD, is Researcher in the Department of Nursing I and Member of the OPIK-Research Group for Social Determinants of Health and Demographic Change, and Elena Rodriguez-Alvarez, PhD, is Professor in the Department of Nursing I and Member of the OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Leioa, Spain. Unai Martin, PhD, is Assistant Professor in the Department of Sociology 2 and Member of OPIK-Research Group for Social Determinants of Health and Demographic Change, and Amaia Bacigalupe, PhD, is Assistant Professor in the Department of Sociology 2 and Member of the OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Leioa, Spain.
Nurs Res. 2018 Jan/Feb;67(1):26-34. doi: 10.1097/NNR.0000000000000256.
Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served.
The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain.
A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women.
Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]).
There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.
卫生服务可能减少由其他健康决定因素导致的不平等，也可能因逆关怀法则的影响而加剧不平等。逆关怀法则指的是，优质医疗服务的可及性往往与所服务人群的需求呈反比。
本研究旨在描述西班牙巴斯克地区公共卫生系统中护理服务、初级保健医疗服务、专科护理服务以及未完全覆盖的服务在使用方面的不平等情况。
对至少25岁且完成2013年巴斯克健康调查的成年人进行了一项横断面研究（N = 10454）。计算了卫生系统覆盖和未覆盖服务使用情况的年龄标准化患病率和患病率比。使用具有稳健方差的泊松回归模型估计卫生服务使用与社会经济变量之间的关联。不平等相对指数（RII）用于衡量卫生服务使用中社会经济地位不平等的程度。所有分析均按性别分别进行。
社会经济地位较低的个体更有可能使用初级保健服务（RII = 0.87，95%CI [0.79, 0.97]），而使用专科服务的可能性较小（RII = 0.82，95%CI [0.75, 0.89]）。在未覆盖的卫生服务中，最高和最低社会群体之间的不平等在所有情况下都很显著，尤其在男性使用物理治疗师（RII = 0.46，95%CI [0.35, 0.61]）和足病医生服务（RII = 0.24，95%CI [0.15, 0.38]）方面表现明显。
基于个体社会经济地位，初级和专科卫生服务的使用存在显著不平等，特别是对于现有卫生系统中不免费提供的服务。这表明，未明确设计为提供普遍可及性的卫生服务系统实际上可能会扩大其目标人群中预先存在的社会和健康不平等。
