Department of Public Health, University of Copenhagen Øster Farimagsgade 5, 1014, København K, Denmark.
DaCHE, Department of Public Health, University of Southern Denmark JB Winsløws Vej 9, 5000, Odense, Denmark.
Soc Sci Med. 2022 Jan;292:114550. doi: 10.1016/j.socscimed.2021.114550. Epub 2021 Nov 17.
Healthcare inequities are often investigated empirically as associations between socio-economic characteristics and differences between observed healthcare utilisation and estimates of needs-based utilisation. However, the concept of 'need' is tricky to operationalise and utilisation may be contingent on inequities arising at an earlier stage. In this study, we apply a unique combination of register and survey data collected in 2019 to assess equity in opportunities to access treatment for patients with recently diagnosed type 2 diabetes. In the study of this population (N = 1864) we escape the challenge of estimating needs by arguing that need can be approximated from treatment guidelines within a nationwide framework of disease management programmes. Furthermore, instead of observed utilisation we use patient reports on whether they have been offered treatment as a measure of opportunities to access multiple components of care, that is, we focus on possible inequalities arising prior to possible utilisation inequalities. 'Healthcare gaps' are computed as the discrepancy between an index of guideline recommended treatments and patients' perceived offers of treatments, thus providing a novel take on the 'healthcare deprivation profiles' approach to the study of healthcare inequalities. Using this method, we explore and document inequalities along multiple dimensions of familiar socio-economic factors (income, education, occupation) as well as self-reported barriers to access. We also provide supporting evidence that healthcare gaps, as measured in our study, are associated with poorer quality of care, and that those who experience large gaps are more likely to be disadvantaged in terms of self-reported difficulties in relation to key self-care aspects. We conclude that even in a health system with comprehensive universal coverage, healthcare inequity can arise already at the stage of offering access to preventive treatment. The results warrant further research into the causes, consequences and remedies of such inequities.
卫生保健不公平现象通常通过实证研究来研究，即研究社会经济特征与观察到的卫生保健利用情况和基于需求的估计之间的差异之间的关联。然而，“需求”的概念难以操作，并且利用情况可能取决于更早阶段出现的不公平现象。在这项研究中，我们应用了 2019 年收集的登记和调查数据的独特组合，评估了最近诊断为 2 型糖尿病患者获得治疗机会的公平性。在对该人群（N=1864）的研究中，我们通过争论说，在全国性疾病管理计划框架内的治疗指南中可以近似估计需求，从而避免了估计需求的挑战。此外，我们没有使用观察到的利用率，而是使用患者是否接受治疗的报告作为衡量多种护理机会的指标，也就是说，我们关注的是在可能出现利用率不平等之前可能出现的不平等。“卫生保健差距”是通过将指南推荐的治疗指数与患者感知的治疗机会进行比较来计算的，因此为研究卫生保健不平等问题的“卫生保健剥夺概况”方法提供了新颖的见解。使用这种方法，我们探索并记录了熟悉的社会经济因素（收入，教育，职业）以及自我报告的获得障碍的多个方面的不平等现象。我们还提供了支持性证据，表明我们研究中测量的卫生保健差距与较差的护理质量相关，并且那些经历较大差距的人在与关键自我保健方面相关的自我报告困难方面可能处于不利地位。我们的结论是，即使在具有全面普遍覆盖的卫生系统中，在提供预防治疗机会时也可能已经出现卫生保健不公平现象。这些结果证明有必要进一步研究这种不公平现象的原因，后果和补救措施。
