瑞士潜在可避免的住院和社会经济地位:一个小区域级分析
Jacques Spycher1, Kevin Morisod2, Karine Moschetti1
1Department of epidemiology and health systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Health policy (Amsterdam, Netherlands)
|December 14, 2023
概括
在瑞士,社会经济地位影响了获得基于社区的门诊护理 (CBAC) 的机会. 更贫困地区的住院率更高,可能可以避免住院,这凸显了医疗保健获取方面的差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 健康的社会经济决定因素
背景情况:
- 瑞士的医疗保健系统面临着高昂的成本和自付费用.
- 基于社会经济地位 (SES) 获得医疗保健的不平等问题越来越令人担忧.
- 在瑞士,SES与社区出院护理 (CBAC) 之间的关联存在有限的研究.
研究的目的:
- 在瑞士进行首个关于社会经济地位与获得社区 ambulatory care (CBAC) 之间的关系的国家研究.
- 量化进入CBAC的社会经济梯度.
- 为了确定这些梯度在国家和州级的变化.
主要方法:
- 在小面积层面上分析2014-2017年行政和医院出院数据.
- 发展一个社会经济贫困指标.
- 利用可能可以避免的住院治疗作为CBAC访问的代理.
- 使用混合效应模型估计社会经济梯度,具有和没有地理位置和医生可用性的控制变量.
主要成果:
- 在最贫困地区,与最贫困地区相比,每1000名人口中有2.80例可能可避免的住院住院病例 (3.01例与对照).
- 在社会经济梯度中观察到显著的州区差异,差异高达5.40 (5.54与对照).
- 社会经济地位显然与获得基本医疗保健服务的差异有关.
结论:
- 解决健康和财务障碍的社会决定因素对于减少医疗保健准入差距至关重要.
- 针对性地加强贫困地区的CBAC服务,可以减轻社会经济差距.
- 政策干预是必要的,以确保在瑞士的所有社会经济层面平等获得门诊护理.
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