Vortragssitzung
Inequality in health
Talks
SOCIOECONOMIC INEQUALITY IN CERVICAL CANCER SCREENING USE IN MOROCCO
Sara HDDA, Mohammed 5 University
Einleitung / Introduction
Early detection of cancer disease would increase the recovery rate and reduce the risk of mortality. In Morocco, a national program for cervical cancer screening has been implemented since 2010 allowing women from targeted age group (30-49) to undertake a screeninng for cervical cancer free of charge in public health facilities. however, the screening rate remains very low.
Methode / Method
This paper aims to investigate factors behind lower screening uptake rate and examine related socioeconomic inequality. Using a sample of 6737 women extracted from the National Health Survey conducted in 2018 by the Moroccan Ministry of Health, this paper applied descriptive statistics and logistic regression to investigate factors behind underuse of cervical cancer screening. Erreygers Concentration indices (EI) were also estimated to examine and assess the socioeconomic gradient at national, regional as well as urban-rural level. Decomposition analysis was then conducted to understand how socioeconomic factors contribute to the overall inequality.
Ergebnisse / Results
Findings reveal a significant pro-rich inequality (EI=0.13) implying that despite being free in public health facilities, cervical cancer screening was concentrated among women from the wealthiest households. There was also some evidence of regional disparity as the Erreygers concentration index was negative in the wealthiest regions in terms of Gross Domestic Product per capita (Laayoune Sakia El Hamra and Dakhla Oued Ed Dahab) while it was significant and positive in seven regions with a magnitude varying from 0.086 in Guelmim-Oued Noun to 0.25 in Casablanca-Settat. Decomposition results show that a great amount of inequality emanates from wealth, accounting for 52%. Location (living in urban area), education and health literacy regarding cervical cancer screening also explain a large portion of inequality.
Zusammenfassung / Conclusion
Yet, targeting social determinants of health such as wealth distribution, access to education, and ensuring equal distribution of healthcare resources within and across regions are essential measures to effectively alleviate inequality in healthcare use.
Authors
Sara HDDA, Mohammed 5 University
yahia el ouazzani, Mohammed 5 University
Socioeconomic Disparities in Excess Mortality and Health Care Utilization During the COVID-19 Pandemic: Evidence from Germany
Esra Eren Bayindir, Universität Hamburg, Hamburg Center for Health Economics
Einleitung / Introduction
Across the globe, populations with low socioeconomic status bore a disproportionate burden of the COVID-19 pandemic. In this work, we examine the relationship between socioeconomic factors (education and income) and all-cause mortality and health care use to better understand the impact of the pandemic on socioeconomic disparities in Germany.
Methode / Method
We employed data from several sources in our analysis. We obtained population data and the annual total deaths on the county level from 2011-21 from the Federal Statistical Office. Data on all of the admissions to hospitals in Germany from 2014-21 are derived from the German Diagnosis Related Groups statistics. The share of high school graduates with a general higher education entrance qualification and the share of the households with low income at the county level from 2011-20 are obtained from INKAR. We considered all inpatient admissions, respiratory admissions, emergency admissions (acute myocardial infarction, appendectomy, and stroke admissions), cancer surgery (breast and colon cancers), elective admissions (hip replacement and tonsillectomy), and ambulatory care sensitive admissions (back pain, chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension). Excess mortality and changes in health care use were computed as deviations from linear annual time trend controlling for age group, sex, and state, and allowing for different impact of the pandemic on mortality and inpatient admissions by age, sex, and education and income levels of the population using linear regression models.
Ergebnisse / Results
The baseline hospital admission rates exposed higher use rates for socioeconomically disadvantaged populations in the pre-pandemic period in general. Among the conditions we considered, emergency admissions were affected the least by the pandemic. Even though the changes in socioeconomic disparities in inpatient use were limited except for ambulatory care sensitive admissions, education is more strongly associated with a change in disparities in hospital admission rates than income in general, despite very similar baseline inequalities by education and income.
Zusammenfassung / Conclusion
In Germany, changes in socioeconomic disparities in all-cause mortality and inpatient use during the COVID-19 pandemic were limited except for the ambulatory care sensitive admissions. By ensuring access to minimum living standards and health care, the presence of a strong social safety net and the universal health care system might have helped mitigate the impact of the pandemic on socioeconomic disparities in all-cause mortality and large parts of inpatient utilization. Providing more guidance on health care use, especially to the population with low health literacy, might help to further diminish socioeconomic disparities in health care use.
Authors
Esra Eren Bayindir, Universität Hamburg, Hamburg Center for Health Economics
Robert Messerle, Universität Hamburg, Hamburg Center for Health Economics
Tom Stargardt, Universität Hamburg, Hamburg Center for Health Economics
Jonas Schreyögg, Universität Hamburg, Hamburg Center for Health Economics
A spatial analysis of outpatient care utilisation of chronic patients in Bavaria during the COVID-19 pandemic
Sebastian Himmler, Technische Universität München
Einleitung / Introduction
Access to outpatient physicians was complicated by the emergence of the COVID-19 pandemic. Patients, due to the fear of becoming infected, have at times avoided visits to the doctor, while some physician offices restricted opening hours and type of visits. Forgone care is particularly problematic for chronically ill patients, where continuous and close-knit care is of particular relevance. The extent of the disruption of care for these patients and possible inequalities are not yet fully assessed. The aim of the analysis is to quantify to what extent the pandemic in Bavaria has affected the utilisation of outpatient medical care by chronically ill patients. In addition, we examine the role of socioeconomic deprivation and spatial accessibility of outpatient physicians for utilisation during the pandemic.
Methode / Method
This study uses outpatient claims data from the Association of Statutory Health Insurance Physicians of Bavaria (KVB) covering the years 2019-2022 and all statutory insured patients with type 2 diabetes and coronary heart disease (CHD). The data is aggregated to quarter and municipality level and supplemented by an index for socio-economic deprivation and further regional characteristics. Age- and sex-standardised outpatient care utillisation rates are calculated separately for GP care and specialist care for the two included indications. Spatial estimation models are used to assess the association of the onset of the Covid-19 pandemic and outpatient care utilisation. A three-way interaction model is estimated to assess the additional change in utilisation during the pandemic in more deprived and more remote areas.
Ergebnisse / Results
We found that the onset of the pandemic was associated with reductions in utilisation of outpatient care by both diabetes and CHD patients. Changes in utilisation were smaller for GP care (up to -5%) and larger for specialist care (up to -10%), in general. We also found that the reductions we found persisted even after the first year of the pandemic, where restrictions were highest. The observed reductions were highest in municipalities with higher socio-economic deprivation and distances to providers.
Zusammenfassung / Conclusion
Given the considerable interruptions the pandemic caused to many aspects of life, the reductions in outpatient care utilisation, even for specialist care, seem to be modest. Our analysis provides a high-level, aggregated perspective on outpatient care utilisation of chronic patients during the pandemic. Future studies based on the individual level could assess which subgroups were most affected in terms of utilisation by the pandemic and what kind of services or medical procedures were provided to a lesser degree.