Urbanos-Garrido Rosa M, Agúndez Laura
Department of Applied Economics, Public Economics and Political Economy, University Complutense of Madrid, Campus de Somosaguas, 28223, Madrid, Spain.
Hospital Universitario La Paz, Madrid, Spain.
Appl Health Econ Health Policy. 2025 Mar 26. doi: 10.1007/s40258-025-00961-0.
To measure socioeconomic-related inequality in perceived unmet needs for financial reasons for mental health care in Spain and to assess socioeconomic-related inequity in access to mental health professionals and psychotropic drugs.
We used data from the Spanish adult sample of the European Health Interview Survey for 2014 and 2020. Corrected concentration indices were used to measure socioeconomic-related inequalities in unmet needs for financial reasons and inequity in access to mental health care. Social class, based on the occupation of the breadwinner, was used as a proxy of socioeconomic status. A decomposition analysis was performed to determine the variables that explain inequalities and to identify inequity in access.
Unmet need for mental health care for financial reasons significantly concentrate on the worse-off, except for women in 2020. A reduction of inequality is observed along the study period. Socioeconomic disadvantage is associated with lower access to mental health consultations, despite also with higher need. This pro-rich inequity is significant for women in 2014, and for both sexes-although much higher for females-in 2020. In contrast, we found pro-poor inequity in women's access to psychotropic drugs in 2020, suggesting partial substitution of specialized health care with psychotropic drugs prescribed in primary care for the financially worse-off.
Barriers to accessing specialized mental health care should be reduced for those in need, particularly for disadvantaged women. A better access to therapy could also help to reduce their consumption of psychotropic drugs. Addressing access inequities requires different strategies for men and women, as the relevance of their determinants varies by gender.
衡量西班牙因经济原因导致的心理健康护理未满足需求方面与社会经济相关的不平等，并评估获得心理健康专业人员和精神药物方面与社会经济相关的不公平现象。
我们使用了2014年和2020年欧洲健康访谈调查西班牙成人样本的数据。校正后的集中指数用于衡量因经济原因导致的未满足需求方面与社会经济相关的不平等以及获得心理健康护理方面的不公平现象。基于养家糊口者职业的社会阶层被用作社会经济地位的代理指标。进行了分解分析，以确定解释不平等现象的变量并识别获得护理方面的不公平现象。
除2020年的女性外，因经济原因导致的心理健康护理未满足需求显著集中在较贫困人群中。在研究期间观察到不平等现象有所减少。社会经济劣势与获得心理健康咨询的机会较低相关，尽管需求也较高。这种有利于富人的不公平现象在2014年的女性中以及在2020年的男女中都很显著，尽管女性的情况更为严重。相比之下，我们发现2020年女性在获得精神药物方面存在有利于穷人的不公平现象，这表明初级保健中为经济状况较差者开具的精神药物部分替代了专科医疗保健。
对于有需要的人，尤其是弱势女性，应减少获得专科心理健康护理的障碍。更好地获得治疗也有助于减少她们对精神药物的消费。解决获得护理的不公平问题需要针对男性和女性采取不同策略，因为其决定因素的相关性因性别而异。
