Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Eur J Public Health. 2020 Apr 1;30(2):223-229. doi: 10.1093/eurpub/ckz211.
In Denmark, a tax-based universal healthcare setting, drug reimbursement for terminal illness (DRTI) should be equally accessible for all terminally ill patients. Examining DRTI status by regions provides new knowledge on inequality in palliative care provision and associated factors. This study aims to investigate geographical variation in DRTI among terminally ill cancer patients.
We linked socioeconomic and medical data from 135 819 Danish cancer decedents in the period 2007-15 to regional healthcare characteristics. We analyzed associations between region of residence and DRTI. Prevalence ratios (PR) for DRTI were estimated using generalized linear models adjusted for patient factors (age, gender, comorbidity and socioeconomic profile) and multilevel models adjusted for both patient factors and regional healthcare capacity (patients per general practitioner, numbers of hospital and hospice beds).
DRTI allocation differed substantially across Danish regions. Healthcare capacity was associated with DRTI with a higher probability of DRTI among patients living in regions with high compared with low hospice bed supply (PR 1.13, 95% CI 1.10-1.17). Also, the fully adjusted PR of DRTI was 0.94 (95% CI 0.91-0.96) when comparing high with low number of hospital beds. When controlled for both patient and regional healthcare characteristics, the PR for DRTI was 1.17 (95% CI 1.14-1.21) for patients living in the Central Denmark Region compared with the Capital Region.
DRTI status varied across regions in Denmark. The variation was associated with the distribution of healthcare resources. These findings highlight difficulties in ensuring equal access to palliative care even in a universal healthcare system.
在丹麦，税收支持的全民医保体系下，绝症药物报销（DRTI）应平等覆盖所有绝症患者。按地区考察 DRTI 状况可提供关于姑息治疗提供方面不平等现象以及相关因素的新知识。本研究旨在调查绝症癌症患者中 DRTI 的地域差异。
我们将 2007-15 年期间 135819 名丹麦癌症死亡者的社会经济和医疗数据与地区医疗保健特征相关联。我们分析了居住地区与 DRTI 之间的关联。使用广义线性模型调整患者因素（年龄、性别、合并症和社会经济状况）和多水平模型调整患者因素和地区医疗保健能力（每位全科医生的患者人数、医院和临终关怀床位数量）来估计 DRTI 的患病率比（PR）。
丹麦各地区的 DRTI 分配差异很大。医疗保健能力与 DRTI 相关，与临终关怀床位供应较低的地区相比，高床位供应地区的 DRTI 可能性更高（PR1.13，95%CI1.10-1.17）。此外，当比较高与低数量的医院床位时，完全调整后的 DRTI 的 PR 为 0.94（95%CI0.91-0.96）。当同时控制患者和地区医疗保健特征时，与首都大区相比，居住在丹麦中部地区的患者的 DRTI 比值比（PR）为 1.17（95%CI1.14-1.21）。
丹麦各地区的 DRTI 状况存在差异。这种差异与医疗资源的分布有关。这些发现突显了即使在全民医保体系中，确保平等获得姑息治疗也存在困难。
