Department of Sociology 2, Alicante University, 03690 Alicante, Spain.
Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden.
Int J Environ Res Public Health. 2018 Jan 12;15(1):121. doi: 10.3390/ijerph15010121.
This paper explores whether the principles of horizontal and vertical equity in healthcare are met by the Spanish national health system in the case of the Roma and general populations. The 2011/2012 Spanish National Health Survey ( = 21,650) and the 2014 National Health Survey of the Spanish Roma Population ( = 1167) were analyzed. Use of healthcare services was measured in terms of visits to a general practitioner (GP), visits to an emergency department, and hospitalizations. Healthcare need was measured using (a) self-rated health and (b) the reported number of chronic diseases. The Roma reported worse self-rated health and a higher prevalence of chronic diseases. A redistributive effect (increased healthcare service use among Roma and those in lower socio-economic classes) was found for hospitalizations and emergency visits. This effect was also observed in GP visits for women, but not for men. Vertical inequity was observed in the general population but not in the Roma population for GP visits. The results suggest the existence of horizontal inequity in the use of GP services (Roma women), emergency department visits (Roma and general population), and hospitalizations (Roma population) and of vertical inequity in the use of GP services among the general population.
本文探讨了西班牙全民健康系统在罗姆人和普通人群中是否符合医疗保健中的水平公平和垂直公平原则。分析了 2011/2012 年西班牙国家健康调查（=21650）和 2014 年西班牙罗姆人国家健康调查（=1167）。使用医疗保健服务的指标包括看普通科医生（GP）的次数、去急诊部的次数和住院次数。医疗保健需求用（a）自我评估健康状况和（b）报告的慢性病数量来衡量。罗姆人报告的自我评估健康状况较差，慢性病患病率较高。发现了一种再分配效应（罗姆人和社会经济地位较低的人住院和急诊就诊次数增加）。这种效应在女性看普通科医生的次数上也有体现，但在男性上没有。在普通人群中观察到垂直不公平，但在罗姆人群体中没有观察到普通科医生就诊的垂直不公平。结果表明，在普通科医生服务（罗姆女性）、急诊就诊（罗姆人和普通人群）和住院治疗（罗姆人群体）的使用方面存在水平不公平，以及在普通人群中普通科医生服务的使用方面存在垂直不公平。
