Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
PLoS One. 2020 Jul 2;15(7):e0234135. doi: 10.1371/journal.pone.0234135. eCollection 2020.
Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types.
This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities.
All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences.
This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
在欧洲国家，健康和死亡率方面的教育不平等问题经常在福利制度或政治制度的背景下进行研究。我们认为，医疗保健系统是与医疗保健可改善的死亡率最直接相关的国家层面特征。在本文中，我们探讨了医疗保健可改善的死亡率方面的教育差异在欧洲国家之间以及欧洲医疗保健系统类型之间存在多大程度的差异。
本研究使用了来自 21 个欧洲人群的数据，涵盖了 35-79 岁的年龄段，时间跨度从 1998 年到 2006 年。ISCED 教育类别用于计算最高和最低教育程度之间的相对（RII）和绝对不平等（SII）。医疗保健系统类型基于最新的可用分类。使用荟萃分析和方差分析检验来确定它们是否以及如何解释国家间不平等的差异，以及是否存在任何医疗保健系统类型具有更高的不平等。
所有国家和医疗保健系统类型都表现出医疗保健可改善的死亡率方面的相对和绝对教育不平等。低供应和低绩效的混合医疗保健系统类型在男性（RII = 3.57；SII = 414）和女性（RII = 3.18；SII = 209）人群中具有最高的不平等点估计值，而以监管为导向的公共医疗保健系统在整体上具有最低的不平等水平（男性 RII = 1.78；男性 SII = 123；女性 RII = 1.86；女性 SII = 78.5）。由于数据限制，结果不够稳健，无法对类型差异做出实质性的断言。
本文旨在讨论连接医疗保健系统、社会地位和健康的可能机制。结果表明，位于医疗保健系统内的因素与健康不平等有关，因为医疗保健可改善的死亡率方面的不平等存在于所有医疗保健系统中。未来的研究应该旨在更详细地研究医疗保健系统特定特征的作用。
