Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

Vikum, Eirik; Krokstad, Steinar; Westin, Steinar

doi:10.1186/1475-9276-11-48

Cited by 58 publications

(78 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, the Norwegian universal public health care system is based on a principle of equal access for all citizens according to needs, and not according to wealth. However, a recently published Norwegian study on self-reported health care utilization in the general population found social inequalities in utilization of specialized health care services [32]. …”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and unmet healthcare needs in Huntington’s disease

Walsem

Howe

Ruud

et al. 2017

Health Qual Life Outcomes

View full text Add to dashboard Cite

BackgroundHuntington’s disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients’ needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL.MethodsIn this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington’s Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients’ HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL.ResultsThe patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to higher HRQoL (β value 0.564; p < 0.001).ConclusionsThe study findings suggest that patients with HD do not receive healthcare services that could have a positive impact on their HRQoL.

show abstract

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and unmet healthcare needs in Huntington’s disease

Walsem

Howe

Ruud

et al. 2017

Health Qual Life Outcomes

View full text Add to dashboard Cite

show abstract

“…However, studies also indicate that this high utilization is mainly explained by the greater health care needs among the poor, and when such differential needs are taken into account, utilization instead favors the well-off [15, 16]. This pattern of overutilization of outpatient care among the rich relative to the poor differs from findings in other Scandinavian countries [17, 18] and most OECD countries [16, 19], where no horizontal inequities have been found after taking health care needs into account. Nevertheless, Swedish and international research has focused on adults [14, 15] or elderly [4].…”

Section: Introductionmentioning

confidence: 99%

Equitable health services for the young? A decomposition of income-related inequalities in young adults’ utilization of health care in Northern Sweden

Mosquera

Waenerlund

Goicolea

et al. 2017

Int J Equity Health

View full text Add to dashboard Cite

BackgroundDespite the goal of the Swedish health system to offer health care according to the principle of horizontal equity, little is known about the equality in access to health care use among young people. To explore this issue, the present study aimed i) to assess horizontal inequity in health care utilization among young people in Northern Sweden; and ii) to explore the contribution of different factors to explain the observed inequalities.MethodsParticipants (N = 3016 youths aged 16–25 years) came from the “Health on Equal terms” survey conducted in 2014 in the four northernmost counties in Sweden. Concentration indices (C) and horizontal inequity indices (HI) were calculated to measure inequalities in the utilization of two health care services (general practitioners (GP) and youth clinics). The HI was calculated based on health care utilization and variables representing socioeconomic status (household income), health care needs factors and non-need factors affecting health care use. A decomposition analysis was carried out to explain the income-related inequalities.ResultsResults showed a significant positive income-related inequality for youth clinic utilization in women (C = 0.166) and total sample (C = 0.097), indicating that services were concentrated among the better-off. In contrast, general practitioner visits showed inequality pointing toward a higher utilization among less affluent individuals; significant in women (C = −0.079), men (C = −0.101) and pooled sample (C = −0.097). After taking health care needs into consideration, the utilization of youth clinics remained significantly pro-rich in women (HI = 0.121) and total sample (HI = 0.099); and consistently pro-poor for the GP visits in the pooled sample (HI = −0.058). The decomposition analyses suggest that socioeconomic inequalities explain a considerable portion of the pro-rich utilization of youth clinics services among young women. The corresponding analyses for GP visits showed that need factors and socioeconomic conditions accounted for the pro-poor concentration of GP visits.ConclusionThe distribution of GP visits among young people in Northern Sweden slightly favored the low-income group, and thus seems to meet the premises of horizontal equity. In contrast, the findings suggest substantial pro-rich horizontal inequity in the utilization of youth clinics among young women, which are largely rooted in socioeconomic inequalities.

show abstract

“…However, the volume of articles differed between chronic diseases: 59 articles (79.7 %) included oncology samples [19, 32–40, 42–47, 50–55, 57–63, 65–72, 74, 76–96]; 12 articles (16.2 %) included depression [32, 33, 41, 62, 64, 75, 83, 93, 97–100]; 10 articles (13.5 %) included diabetes [18, 32, 33, 64, 74, 75, 83, 101–103]; 10 articles (13.5 %) included ischaemic heart disease [18, 32, 33, 48, 56, 64, 74, 75, 83, 102]; 7 articles (9.5 %) included COPD [32, 33, 49, 56, 74, 75, 102]; 7 articles (9.5 %) included asthma [18, 32, 33, 64, 74, 75, 83]; 6 articles (8.1 %) included arthritis [32, 33, 73–75, 83]; and 3 articles (4.1 %) included osteoporosis [73–75]. A total of 12 studies (16.2 %) included more than one disease of interest [18, 32, 33, 56, 62, 64, 73–75, 83, 93, 102].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?

Fradgley

Paul

Bryant

2015

Int J Equity Health

View full text Add to dashboard Cite

Health utilization and need assessment data suggest there is considerable variation in access to outpatient specialist care. However, it is unclear if the types of barriers experienced are specific to chronic disease groups or experienced universally. This systematic review provides a detailed summary of common and unique barriers experienced by chronic disease groups when accessing and receiving care, and a synthesized list of possible health service initiatives to improve equitable delivery of optimal care in high-income countries. Quantitative articles describing barriers to specialist outpatient services were retrieved from CINAHL, MEDLINE, Embase, and PyscINFO. To be eligible for review, studies: were published from 2002 to May 2014; included samples with cancer, diabetes mellitus, osteoporosis, arthritis, ischaemic heart disease, stroke, asthma, chronic pulmonary disorder (COPD) or depression; and, were conducted in high-income countries. Using a previously validated model of access (Penchansky and Thomas’ model of fit), barriers were grouped according to five overarching domains and defined in more detail using 33 medical subject headings. Results from reviewed articles, including the scope and frequency of reported barriers, are conceptualized using thematic analysis and framed as possible health service initiatives. A total of 3181 unique records were screened for eligibility, of which 74 studies were included in final analysis. The largest proportion of studies reported acceptability barriers (75.7 %), of which demographic disparities (44.6 %) were reported across all diseases. Other frequently reported barriers included inadequate need assessment (25.7 %), information provision (32.4 %), or health communication (20 %). Unique barriers were identified for oncology, mental health, and COPD samples. Based on the scope, frequency and measurement of reported barriers, eight key themes with associated implications for health services are presented. Examples include: common accommodation and accessibility barriers caused on service organization or physical structure, such as parking and appointment scheduling; common barriers created by poor coordination of care within the healthcare team; and unique barriers resulting from inadequate need assessment and referral practices. Consideration of barriers, across and within chronic diseases, suggests a number of specific initiatives are likely to improve the delivery of patient-centered care and increase equity in access to high-quality health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0179-6) contains supplementary material, which is available to authorized users.

show abstract

Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

Cited by 58 publications

References 18 publications

Health-related quality of life and unmet healthcare needs in Huntington’s disease

Health-related quality of life and unmet healthcare needs in Huntington’s disease

Equitable health services for the young? A decomposition of income-related inequalities in young adults’ utilization of health care in Northern Sweden

A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?

Contact Info

Product

Resources

About