Assessment of Equity in Access to Percutaneous Coronary Intervention (PCI) Centres in Poland

Abstract

The purpose of this study is to analyse the disparities in the distribution of percutaneous coronary intervention (PCI) centres in Poland and the impact of eventual inequities on access to the invasive treatment of acute myocardial infarctions (AMI). To examine the distribution of PCI centres against population size and geographic size in Poland, the Gini coefficient calculated based on the Lorenz Curve was engaged. In addition, the regression function was employed to estimate the impact of distribution of PCI centres on access to invasive procedures (coronarographies and primary percutaneous coronary intervention). Data were collected from the public statistical system and Polish National Health Fund database for the year 2018. The relation and the level of equity was measured based on the aggregated data at a district (voivodeship) level. The results of the Gini coefficient analysis show that the distribution of invasive cardiology units measured against population size is more equitable than when measured against geographic size. In addition, the regression analysis shows the moderate size of the positive correlation between number of PCI centres per 100,000 population and the number of all categories of the invasive treatment of AMI per 100,000 population, and the lack of similar correlation in case of the number of PCI centres expressed per 1000 km2, which could be evidence of an insufficiency of PCI centres in areas where the concentration of PCI centres per 100,000 population is lower. The main implication for policy makers that results from this research is the need for a correction of PCI centres distribution per 100,000 inhabitants to ensure better access to invasive procedures.

Socioeconomic Determinants of Health and Their Unequal Distribution in Poland

“…The Theil index ranges between 0 and ∞, where zero represents an equal distribution and any higher value represents a higher level of disproportion. Other commonly used methods to measure the level of inequity in the context of health and health care are the Gini index [38,52,59] and concentration index [57,58,60]. Compared with the Gini coefficient, when estimating regional differences, the Theil index allows sub-groups to be broken down within the context of larger groups.…”

“…As reducing health inequities is treated as a matter of social justice and is thus a kind of ethical imperative, the Commission on Social Determinants of Health called on the WHO and all governments "to lead global action on the social determinants of health with the aim of achieving health equity" [12]. In the Polish health care system, both health and equity are important values [52,53], as determined from the WHO constitution and strategy [2] as well as from Article 68 of the Polish Constitution [54]. In addition, one of the strategic objectives of the Polish national health policy, as formulated in the National Health Programme [55], is the elimination of geographical and social inequalities in health.…”

Inequity in the Access to eHealth and Its Decomposition Case of Poland

“…Theil index is also one of the commonly used measures of inequity in the healthcare sector [ 64 , 65 , 66 , 67 , 68 ]. Other methods used are either Gini index [ 69 , 70 , 71 , 72 , 73 ] or concentration index [ 74 , 75 , 76 ]. Compared to other methods, the Theil index makes it possible to identify the main sources of the total differences by measuring the contribution of both intra- and inter-regional differences to the total inequity [ 77 ].…”

Regional Variability in the Access to Cardiac Rehabilitation in Poland

“…Moreover, equal access to health services is one of the priorities of Polish health policy [ 47 ] and an important value of the healthcare system, as in the case of many healthcare systems over the world [ 48 ]. In addition, the establishment and development of CR services is essential for the most effective management of heart conditions [ 11 , 49 ].…”