PDF(Pubmed)
Abstract：
Spatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.
We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.
A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).
Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.
Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.
We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.
A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).
Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.
Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.
摘要：
■空间隔离，在欧洲，社会经济贫困的社区在医疗保健方面面临被忽视的风险。在匈牙利,监测系统薄弱，对这些隔离地区人民健康状况的了解不足，阻碍了为这些脆弱社区制定消息灵通的有效干预措施。
■我们使用国家健康保险基金管理部门提供的数据来更好地描述隔离社区的医疗保健绩效，并开发更强大的监控系统。
■使用2020年医疗保健数据对匈牙利的每个一般医疗实践（GMP）进行了横断面研究，为隔离和非隔离（补充）成年患者提供护理。根据一项政府法令对隔离区域进行了映射和确定，该法令将其定义为教育水平和收入水平低的成年人的定居点。年龄,性别,和获得豁免证书的医疗服务标准化指标的资格，报销,对隔离和非隔离的成年人群体计算过早死亡率，并在国家一级进行汇总。隔离和非隔离特定指标的比率(相对风险，RR)用相应的95%置信区间(95%CI)计算。
■检测到每个指标的GMPs之间的广泛变化。隔离组的医疗保健服务使用率明显高于补充组（RR=1.22，95％CI：1.219;1.223），而医疗保健报销显着减少（RR=0.940，95％CI：0.929;0.951）。在隔离患者中，过早死亡的风险显著较高（RR=1.184，95%CI：1.087；1.289）。总之,生活在隔离地区导致医疗保健服务的访问量增加了18.1％，医疗支出减少了6.6％。
■居住在隔离地区的成年人比居住在非隔离地区的成年人更频繁地使用医疗保健服务；然而，他们获得的医疗报销金额明显较低，表明护理质量较低。隔离的成年人的健康状况明显较低，正如他们更高的过早死亡率所证明的那样。这些发现表明有必要对这一弱势群体进行干预。因为我们的研究揭示了GMPs之间的严重差异，针对隔离的监测对于支持对当地问题敏感的计划和建立必要的基准是必要的。
■我们使用国家健康保险基金管理部门提供的数据来更好地描述隔离社区的医疗保健绩效，并开发更强大的监控系统。
■使用2020年医疗保健数据对匈牙利的每个一般医疗实践（GMP）进行了横断面研究，为隔离和非隔离（补充）成年患者提供护理。根据一项政府法令对隔离区域进行了映射和确定，该法令将其定义为教育水平和收入水平低的成年人的定居点。年龄,性别,和获得豁免证书的医疗服务标准化指标的资格，报销,对隔离和非隔离的成年人群体计算过早死亡率，并在国家一级进行汇总。隔离和非隔离特定指标的比率(相对风险，RR)用相应的95%置信区间(95%CI)计算。
■检测到每个指标的GMPs之间的广泛变化。隔离组的医疗保健服务使用率明显高于补充组（RR=1.22，95％CI：1.219;1.223），而医疗保健报销显着减少（RR=0.940，95％CI：0.929;0.951）。在隔离患者中，过早死亡的风险显著较高（RR=1.184，95%CI：1.087；1.289）。总之,生活在隔离地区导致医疗保健服务的访问量增加了18.1％，医疗支出减少了6.6％。
■居住在隔离地区的成年人比居住在非隔离地区的成年人更频繁地使用医疗保健服务；然而，他们获得的医疗报销金额明显较低，表明护理质量较低。隔离的成年人的健康状况明显较低，正如他们更高的过早死亡率所证明的那样。这些发现表明有必要对这一弱势群体进行干预。因为我们的研究揭示了GMPs之间的严重差异，针对隔离的监测对于支持对当地问题敏感的计划和建立必要的基准是必要的。
