Socioeconomic variation in the burden of chronic conditions and health care provision – analyzing administrative individual level data from the Basque Country, Spain

Abstract

BackgroundChronic diseases are posing an increasing challenge to society, with the associated burden falling disproportionally on more deprived individuals and geographical areas. Although the existence of a socioeconomic health gradient is one of the main concerns of health policy across the world, health information systems commonly do not have reliable data to detect and monitor health inequalities and inequities. The objectives of this study were to measure the level of socioeconomic-related inequality in prevalence of chronic diseases and to investigate the extent and direction of inequities in health care provision.MethodsA dataset linking clinical and administrative information of the entire population living in the Basque Country, Spain (over 2 million individuals) was used to measure the prevalence of 52 chronic conditions and to quantify individual health care costs. We used a concentration-index approach to measure the extent and direction of inequality with respect to the deprivation of the area of residence of each individual.ResultsMost chronic diseases were found to be disproportionally concentrated among individuals living in more deprived areas, but the extent of the imbalance varies by type of disease and sex. Most of the variation in health care utilization was explained by morbidity burden. However, even after accounting for differences in morbidity, pro-poor horizontal inequity was present in specialized outpatient care, emergency department, prescription, and primary health care costs and this fact was more apparent in females than males; inpatient costs exhibited an equitable distribution in both sexes.ConclusionsAnalyses of comprehensive administrative clinical information at the individual level allow the socioeconomic gradient in chronic diseases and health care provision to be measured to a level of detail not possible using other sources. This frequently updated source of information can be exploited to monitor trends and evaluate the impact of policy reforms.

The prevalence of diabetes-related complications and multimorbidity in the population with type 2 diabetes mellitus in the Basque Country

“…In most cases, criteria were based on considering that a person has a chronic disease because they have been assigned the corresponding diagnosis (for example, hypertension); for some illnesses other criteria were applied: diagnosis or prescription of specific medications (e.g., for hypothyroidism and Parkinson’s); repeated diagnosis over several years (low back pain); any history of the diagnosis together with prescription of specific drugs in the previous year (asthma and epilepsy); diagnosis the previous year or repeated prescriptions over several months (depression and anxiety); or repeated prescriptions to treat the given health problem (treated dyspepsia). Further information of this methodology can be found in previous publications [ 25 ]. From such 52 health problems list, diabetes mellitus was excluded, and such group was split in two parts: 1) Related chronic comorbidities, that , according to the bibliography [ 8 ], included 7 pathologies: ischaemic heart disease, renal failure, stroke, heart failure, peripheral neuropathy, foot ulcers and diabetic retinopathy; and 2) unrelated chronic diseases, that corresponds to the remaining 44 health problems of the list.…”

Comorbidity and Healthcare Expenditure in Women with Osteoporosis Living in the Basque Country (Spain)

“…Previous studies by this research group have revealed high levels (91%) of coexisting disease among women with osteoporosis over 65 years old [ 15 ]. Furthermore, osteoporosis and bronchiectasis are the only two diseases, out of a list of 52, disproportionally more prevalent among women living in richer areas in the Basque Country [ 16 ].…”

Investigating Inequalities in Access to Healthcare: The Case of Townships of Kermanshah, Iran

“…Health systems are always faced with key challenges in relation to primary healthcare. These include developing and retaining workforce, information management, financing the health sector and fair provision[1], distribution of infrastructure and resource allocation management [2,3],affordability, availability and accessibility of health services [4][5][6], and matching services to the needs of the public [7,8]. Based on researches access to health services is a multi factorial issue and dependent on many differ determinate factors including: presence of facilities, personnel population density, socio-economic status, payments required, transport, willingness of health services to accept cultural minorities, physical accessibility for people with disabilities, gender considerations, and cultural attitudes and beliefs about health services and their usefulness.…”

“…Besides, higher access and use of health services is more needed for some at risk groups such as: mothers, babies, older people or others in the population whose health is relatively more at risk-for example those with chronic health conditions [9][10][11][12][13][14]. In a situation where the provision of services is traditionally measured by indexes such as the number of physicians and hospital beds per unit of population [15], the fair distribution of health services has always been one of the major concerns of health systems worldwide [8,16]. Not to mention, despite the growing rate of economic growth and dramatic advances in the health sector in the last century, there are still huge inequalities in this respect [17][18][19],and this has even been one of the main challenges in developed countries [20], especially in Iran [21].…”

“…Since unbalanced distribution of services leads to the inefficiency and inappropriate service provision [17,24],(e.g., imbalances in health workforce in terms of quantity, quality, and distribution), will have consequences for health [25].In 2008, the world health organization (WHO) announced that all people should have access to healthcare in accordance with their needs, regardless of their payment power [26].The lack of proper access to medical care in societies has resulted in negative consequences, such as social inequity, increased disease, growing mortality from illnesses, accidents and unbalanced distribution of services [17,24,27]. Research indicates that inappropriate concentration of facilities and medical care is seen as a major problem in many countries [8,24,[28][29][30][31]. This problem has also been observed in Iran [25].Similarly, in Iran, Shahabi et al (2010) reported that the privileged provinces were three times better than the underprivileged ones in terms of the ratio of physicians, hospital beds, laboratories and radiology services to the population [32].In another similar study conducted by TahariMehrjooyi et al (2011), the status of development and ranking of Iranian provinces were addressed in terms of access to the indexes of the health sector.…”