Sezione di Igiene, Medicina Preventiva e Sanità Pubblica - Dipartimento di Scienze Biomediche e Sanità Pubblica - Facoltà di Medicina e Chirurgia - Università Politecnica delle Marche, Ancona, Italy.
PLoS One. 2018 Jun 12;13(6):e0196673. doi: 10.1371/journal.pone.0196673. eCollection 2018.
According to the principle of horizontal equity, individuals with similar need may have the same possibility of access to health services. The aim of this study is to identify patterns of diagnostic services utilization, in people with, and without chronic disease in Italy.
Secondary analysis of data from the national survey on Health and use of health care in Italy, carried out in 2013, including 99,497 participants. Multilevel analysis has been used to study the variables associated to diagnostic services utilization.
13.78% of participants have had one diagnostic testing in the four weeks before the interview. In healthy people, utilization of diagnostic testing is reduced in people with low educational level (OR 0.75; 95%CI 0.67-0.84), in housewives (OR 0.66; 95%CI 0.51-0.87), or in those unable to work (OR 0.48; 95%CI 0.26-0.87), while increased in those perceiving a worse health status (up to OR 4.00, 95%CI 2.00-8.01 in very bad health). In people afflicted with chronic disease, access to diagnostic assessment is impaired by educational level (OR 0.69; 95%CI 0.61-0.78) and low household income (OR 0.75; 95%CI 0.58-0.97), while it is increased in the presence of a ticket exemption (OR 1.55, 95%CI 1.42-1.68), and fixed-term occupation (OR2.28, 95%CI 1.31-3.95). Being former-smokers in associated to an increased utilization of services in both groups.
Despite a universal and theoretically egalitarian, public, health care system, variations in diagnostic services utilization are still registered in Italy, both in healthy people and those afflicted by chronic diseases, on socio-economic/occupational basis, and self-perceived health status. Moreover, this significant effect of occupation on healthcare utilization, suggests the need for a comprehensive evaluation of economics in occupational health.
根据水平公平原则，具有相似需求的个体可能具有相同的获得卫生服务的机会。本研究旨在确定意大利有和没有慢性病的人群对诊断服务的利用模式。
对 2013 年在意大利进行的国家卫生和卫生保健使用调查的数据进行二次分析，共纳入 99497 名参与者。使用多水平分析研究与诊断服务利用相关的变量。
在接受访谈前四周内，有 13.78%的参与者接受过一次诊断性检查。在健康人群中，文化程度较低的人群（OR0.75；95%CI0.67-0.84）、家庭主妇（OR0.66；95%CI0.51-0.87）或无法工作的人群（OR0.48；95%CI0.26-0.87）接受诊断性检查的比例较低，而自感健康状况较差的人群（最高 OR4.00，95%CI2.00-8.01 为非常差）则较高。在患有慢性病的人群中，教育程度（OR0.69；95%CI0.61-0.78）和低收入家庭（OR0.75；95%CI0.58-0.97）会影响获得诊断评估的机会，而免票（OR1.55，95%CI1.42-1.68）和固定期限就业（OR2.28，95%CI1.31-3.95）则会增加机会。曾经吸烟的人群在两组中均与服务利用率的增加有关。
尽管意大利实行了普遍的、理论上平等的、公共的卫生保健制度，但在健康人群和患有慢性病的人群中，基于社会经济/职业和自我感知的健康状况，仍存在诊断服务利用方面的差异。此外，职业对医疗保健利用的这种显著影响表明，需要对职业健康中的经济学进行全面评估。
