Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
BMC Public Health. 2024 Oct 1;24(1):2678. doi: 10.1186/s12889-024-20147-y.
National health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries. In this study, we aim to compare inequality within and between 16 economically diverse countries.
Online surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers' concentration indices and compares these values between countries using a Spearman's rank correlation coefficient.
Results show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers' concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges.
During the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists.
各国的卫生系统具有不同的优势和弹性水平。在 COVID-19 大流行期间，资源经常不得不重新分配，这对许多国家的医疗服务的可及性产生了影响。迄今为止，关于国家内部和国家之间医疗保健可及性不平等的定量当代研究很少。在这项研究中，我们旨在比较 16 个经济多样化国家内部和国家之间的不平等。
2022 年在六大洲的 16 个国家进行了 22150 名成年人的在线调查。使用配额抽样和事后分层加权法获得了年龄、性别、地理和教育代表性样本。该研究使用特定国家扩大的健康需求调整 Erreygers 集中指数评估大流行期间获得医疗保健的挑战（针对全科医生、手术/临床和数字全科医生服务）的差异，并使用 Spearman 秩相关系数比较这些国家之间的差异。
结果显示，不同类型的护理在国家内部存在广泛的与收入相关的获得医疗保健的挑战。例如，哥伦比亚数字服务的 Erreygers 集中指数为 0.17，表现出高度倒退的不平等，而日本的指数为-0.15。国家之间的不平等也很明显，数字和手术服务的 Spearman 秩系数分别为-0.69 和-0.65（p 值分别为 0.003 和 0.006），表明收入较低的国家在获得医疗保健的挑战方面存在更大的不平等。
在大流行期间，中低收入国家面临的获取医疗保健的挑战的不平等程度最大。如果提供足够的支持和可访问的数字基础设施，数字技术为解决其中一些不平等提供了合理的手段。
