ABSTRACT
OBJECTIVES: Health inequity across social classes is closely associated with unequal healthcare utilization, and there have been sustained efforts to improve healthcare accessibility. Public healthcare insurance is one attempt to eliminate such health inequities. The purpose of this study was to examine a horizontal equity index for dental service utilization, which included diverse factors affecting health inequity, such as personal health and social context variables. METHODS: The 2008 to 2011 outpatient datasets of the Korean Healthcare Panel were analyzed. Zero-inflated negative binomial regression (ZINB) was conducted to estimate need-adjusted healthcare use with the following independent variables: health outcome (EQ-5D), chronic disease, and the Composite Deprivation Index. The concentration index and horizontal inequality index were calculated for the actual use of dental services and resource use-based dental visits. RESULTS: The ZINB regression analysis showed that age and personal health level on the EQ-5D were significant predictors, and the Composite Deprivation Index was influential. The concentration index for dental service utilization indicated that there was inequity favoring high-income brackets, but there was inequity favoring low-income groups when health level was taken into account. Overall, the horizontal equity index for dental service utilization estimated based on the two values was positive, meaning that there was inequity favoring high-income groups. CONCLUSIONS: The use of dental services has been steadily on the rise, and dental service accessibility and public healthcare coverage seem to have expanded. However, when the horizontal equity index for dental service utilization was estimated based on health level, there was inequity, with high-income groups making more use of dental services. Thus, equal access to dental services is not guaranteed, despite the adjustment for need. Methods of increasing dental service use in different income brackets must be carefully considered to remove disparities in the use of dental services.
Subject(s)
Humans , Chronic Disease , Dataset , Delivery of Health Care , Health Status , Insurance , Outpatients , Social Class , Socioeconomic FactorsABSTRACT
Objetivo Describir las inequidades en mortalidad materna en Colombia para los años 2000-2001, 2005-2006 y 2008-2009. Métodos Estudio ecológico. Se estimaron las Razones de Mortalidad Materna (RMM) ajustadas por edad materna, para los Departamentos de Colombia, y para las causas de mortalidad materna. Se describen las principales causas de mortalidad para los periodos (2000-2001), (2005-2006) y (2008-2009). Se calculó el exceso de riesgo de muertes maternas en Colombia contra el mejor referente externo a través de la Fracción atribuible (FA). La FA se correlacionó con el indicador de necesidades básicas insatisfechas (NBI) por Departamentos Resultados Las RMM más altas en Colombia estuvieron entre 81 y 161, las más bajas entre 3 y 5. Las RMM más bajas en el mundo estuvieron entre 2 y 4 por 100.000 nacidos vivos para esos periodos. Las principales causas de mortalidad materna en Colombia fueron: hipertensión durante el embarazo, condiciones obstétricas no clasificadas, y complicaciones durante el parto. Se encontró un exceso de riesgo de mortalidad materna en Colombia en promedio del 86 %, cuando se comparó contra un referente externo. Se encontró una correlación entre la FA y el NBI. Conclusiones Existe una gran inequidad en la mortalidad materna dentro de Colombia y al comparar Colombia con los países desarrollados. Las inequidades en la mortalidad materna persisten a pesar de lo avanzado de la reforma del sistema de salud, lo que sugiere que ésta no ha sido efectiva en disminuir la mortalidad materna y sus inequidades.
Objective Describing inequality regarding maternal mortality in Colombia for 2000-2001, 2005-2006 and 2008-2009. Methods This was an ecological study. The maternal mortality rate (MMR) was estimated, adjusted for maternal age, Colombian department and causes of maternal mortality. The main causes of mortality were described for 2000-2001, 2005-2006 and 2008-2009. The excess of risk of maternal death in Colombia was calculated regarding the best external referent using the attributable fraction (AF). The AF was correlated with the indicator of unsatisfied basic needs (UBN) by department. Results The highest MMR in Colombia was between 81 and 161 per 100,000 live births and the lowest between 3 and 5; the lowest MMR in the world was between 2 and 4 per 100,000 live births for the same periods. The main causes of maternal mortality in Colombia were hypertension during pregnancy, unclassified obstetric conditions and complications when giving birth. An excess of risk of maternal mortality in Colombia was found (on average 86 %) when compared to an external referent. A correlation was found between AF and UBN. Conclusions Great inequality was found regarding maternal mortality in Colombia and when comparing Colombia to developed countries. Inequality regarding maternal mortality persists in spite of advances having been made regarding reform of the healthcare system, thereby suggesting that this has not been effective in reducing maternal mortality and its inequalities.