PDF(Pubmed)
Abstract：
BACKGROUND: Overall, research on social determinants of access and quality of outpatient care in Germany is scarce. Therefore, social disparities (according to sex, age, income, migration background, and health insurance) in perceived access and quality of consultation in outpatient care (primary care physicians and specialists) in Germany were explored in this study.
METHODS: Analyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach\'s Alpha 0.89).
RESULTS: In terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.
CONCLUSIONS: We found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.
METHODS: Analyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach\'s Alpha 0.89).
RESULTS: In terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.
CONCLUSIONS: We found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.
摘要：
背景：总的来说，在德国，关于门诊病人获得和质量的社会决定因素的研究很少。因此,社会差距(根据性别，年龄,收入,迁移背景,和健康保险）在这项研究中探讨了德国门诊护理（初级保健医生和专家）的感知访问和咨询质量。
方法：使用横断面在线调查进行分析。从离线招募的小组中随机抽取成年人口样本（N=2,201）。通过预约的等待时间（以天为单位）和练习的旅行时间（以分钟为单位）来评估感知的访问权限。咨询质量是通过咨询时间(分钟)和沟通质量(四个项目的规模,克朗巴赫的阿尔法0.89）。
结果：就初级保健而言，与男性相比，女性的咨询机会和质量较差。与私人保险受访者相比，拥有法定健康保险的人的估计咨询时间较短。关于专科护理，60岁及以上的人报告等待时间更短，沟通质量更高。低收入群体报告沟通质量较低，而在有法定健康保险的受访者中，咨询的可达性和质量较差。社会特征所解释的差异在感知访问的范围内介于1％至4％之间，在咨询质量方面介于3％至7％之间。
结论：我们发现，在德国门诊护理中，人们对咨询的可得性和质量存在社会差异。这种获取上的差异可能表明结构性歧视，而咨询质量的差异可能表明医疗保健中的人际歧视。
方法：使用横断面在线调查进行分析。从离线招募的小组中随机抽取成年人口样本（N=2,201）。通过预约的等待时间（以天为单位）和练习的旅行时间（以分钟为单位）来评估感知的访问权限。咨询质量是通过咨询时间(分钟)和沟通质量(四个项目的规模,克朗巴赫的阿尔法0.89）。
结果：就初级保健而言，与男性相比，女性的咨询机会和质量较差。与私人保险受访者相比，拥有法定健康保险的人的估计咨询时间较短。关于专科护理，60岁及以上的人报告等待时间更短，沟通质量更高。低收入群体报告沟通质量较低，而在有法定健康保险的受访者中，咨询的可达性和质量较差。社会特征所解释的差异在感知访问的范围内介于1％至4％之间，在咨询质量方面介于3％至7％之间。
结论：我们发现，在德国门诊护理中，人们对咨询的可得性和质量存在社会差异。这种获取上的差异可能表明结构性歧视，而咨询质量的差异可能表明医疗保健中的人际歧视。
