Horizontal equity in health care utilization evidence from three high-income Asian economies
Horizontal equity in health care utilization evidence from three high-income Asian economies
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DOI：
10.1016/j.socscimed.2006.08.033
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发表时间：
2007-01-01
影响因子：
5.4
通讯作者：
O'Donnell, Owen
中科院分区：
文献类型：
--
作者：
Lu, Jui-fen R.;Leung, Gabriel M.;O'Donnell, Owen
本文比较了香港、韩国和台湾的医疗保健服务体系中“平等对待同等需要”（ETEN）原则的维持程度。根据需要分配医疗保健的程度的偏差是通过横向不平等指数来衡量的。与收入相关的利用不平等分为四个主要来源：（i）收入的直接影响； (ii) 需求指标（自我评估的健康状况、活动限制以及年龄和性别交互项）； (iii) 非需求变量（教育、工作状况、私人医疗保险覆盖范围、雇主提供的医疗福利、医疗补助状况（低收入医疗救助）、地理区域和城市/农村居住权，以及 (iv) 剩余期限。研究的服务类型包括西医、执业传统医师 (LTMP)、牙科和急诊室 (ER) 就诊以及住院。违反 ETEN 原则的是 观察香港的医生和牙科服务。西方看病存在有利于富人的不平等现象。不同寻常的是，这种不平等存在于全科医生而非专科护理中。相比之下，韩国似乎几乎全面维持了 ETEN，尽管较富裕的人可以优先获得更高水平的门诊护理。台湾的中间结果显示，富人使用门诊服务的可能性略高，但门诊服务的数量 西方医生和牙科就诊分布均匀，而 LTMP 发作次数存在适度的偏向富人的偏见。台湾的急诊就诊和住院人数要么成比例，要么稍微有利于穷人。未来的工作应侧重于评估旨在减少观察到的不平等分配的政策干预措施。 (c) 2006 Elsevier Ltd. 保留所有权利。
This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong. There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions. (c) 2006 Elsevier Ltd. All rights reserved.