背景:尽管最近进行了大量的精神医疗改革以增加医疗供应,澳大利亚的心理健康不平等正在加剧。缺乏对澳大利亚公私混合医疗保健系统中精神病服务使用的不平等程度(未满足的需求差距)的了解。
目的:提出一种新的方法来衡量精神病治疗中的不公平性。
方法:数据来自家庭的第9波(2009年,n=11,563)和第17波(2017年,n=16,194),澳大利亚收入和劳动动态(HILDA)调查。采用多元逻辑回归来估计精神病护理利用率与其需求相比,并使用Gini指数来估计利用率的标准化分布,以衡量不平等的程度。
结果:结果显示,2009年和2017年,精神病护理利用中的不公平指数(需要标准化的基尼)显著,分别为0.066和0.096。对于所有的个人。2009年,男性和女性的不平等指数分别为0.051和0.078,分别,城乡居民0.045和0.068,分别。2017年,男女指数分别为0.081和0.109,分别,城乡居民0.086和0.097,分别。
结论:这项研究显示,自2009年以来,精神科护理的未满足需求显著增加。在澳大利亚,更需要制定政策以改善精神病护理利用的公平性。
BACKGROUND: Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia\'s mixed public-private health care system is lacking.
OBJECTIVE: To present a novel method to measure inequity in the delivery of psychiatric care.
METHODS: Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the
Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity.
RESULTS: The results show the inequity indices (need-standardised
Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively.
CONCLUSIONS: This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.