Institute of Health and Environment, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.
Health Insurance Review & Assessment Service, 101 Daehak-ro, Jongno-gu, Wonju-si 07061, Korea.
Int J Qual Health Care. 2021 May 28;33(2). doi: 10.1093/intqhc/mzab081.
Healthcare quality assessment is being conducted in many countries. Although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socio-economic statuses show the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socio-economic statuses in the same hospitals nationwide.
To determine whether the mortality rate of acute stroke patients differs according to socioeconomic status.
This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10 399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10 228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socio-economic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general population or Medical Aid (MA) for the vulnerable. The primary outcomes measured according to socio-economic status were in-hospital mortality rate and 1-year follow-up mortality rate of stroke patients. The secondary outcome was the composite performance score.
MA recipients had a higher in-hospital mortality rate (12.5 vs. 8.3%, P < 0.001) and 1-year follow-up mortality rate (14.9 vs. 10.8%, P < 0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, P = 0.02). In hospitals of the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant.
There is a difference in mortality and healthcare performance according to socio-economic status in stroke patients in Korea. Efforts to improve equity are needed, including the development and monitoring of equality indicators and developing policies for healthcare equity.
许多国家都在进行医疗质量评估。尽管提高卫生公平性是医疗质量评估的主要目标之一，但在相同医疗质量的医院中，不同社会经济地位的人群是否表现出相同的健康结果尚不清楚。没有研究直接比较全国范围内相同医院中不同社会经济地位的人群的健康结果。
确定急性脑卒中患者的死亡率是否因社会经济地位而异。
本研究是一项回顾性、观察性研究，对 2013 年接受急性脑卒中质量评估的患者进行了研究。共纳入 10399 例脑卒中病例。在评估死亡率时，研究人员分析了 10228 例病例，排除了 171 例同一人两次测量的病例。社会经济地位水平根据医疗保险的使用情况进行划分，即全民健康保险（NHI）或弱势群体的医疗援助（MA）。根据社会经济地位测量的主要结果是脑卒中患者的住院死亡率和 1 年随访死亡率。次要结果是综合表现评分。
MA 受助人的住院死亡率（12.5%比 8.3%，P<0.001）和 1 年随访死亡率（14.9%比 10.8%，P<0.001）均高于 NHI 订阅者。MA 受助人的评分略低于 NHI 订阅者（83.2 比 84.4，P=0.02）。在相同等级的医院中，MA 受助人的表现评分低于 NHI 订阅者，尽管差异无统计学意义。
韩国脑卒中患者的死亡率和医疗保健绩效存在差异。需要努力提高公平性，包括制定和监测平等指标以及制定医疗保健公平政策。
