Alberts J F, Sanderman R, Eimers J M, van den Heuvel W J
Medical and Public Health Service of Curaçao, Epidemiology and Research Unit, Netherlands Antilles.
Soc Sci Med. 1997 Jul;45(2):213-20. doi: 10.1016/s0277-9536(96)00338-3.
The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.
本研究的目的是考察荷属安的列斯群岛库拉索岛在医疗保健利用方面是否存在社会经济公平性。我们探讨教育水平如何与全科医生、专科医生、医院、牙医和物理治疗师的利用情况相关，同时考虑性别、年龄和健康不平等的影响。该研究还考察了这些关系是否因分析单位而异：服务使用的概率（或发生率）与总体接触量。数据源自库拉索岛健康研究，这是一项对18岁及以上非机构化人口的随机样本（N = 2248）进行的健康访谈调查。结果表明，库拉索岛在医疗保健利用概率方面存在社会经济不公平。教育水平较高的人更有可能咨询专科医生、牙医或物理治疗师，也更有可能住院。这不仅在考虑健康方面社会经济不平等（需求）的中介作用时如此，在对健康不平等进行调整之前也是如此。换句话说：似乎既存在纵向不公平（即更大的服务需求未通过更多的使用得到满足），也存在横向不公平（即相似的护理需求未通过相似的服务使用水平得到满足）。观察到的在专科医生和医院利用方面的不平等与国际研究结果形成对比。医疗服务使用量（即咨询次数）似乎与一个人在社会经济地位等级中的位置几乎没有关联；只有牙医服务被受教育程度较高者更广泛地使用。
