How a universal health system reduces inequalities: lessons from England
How a universal health system reduces inequalities: lessons from England
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DOI：
10.1136/jech-2015-206742
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发表时间：
2016-07-01
影响因子：
6.3
通讯作者：
Cookson, Richard
中科院分区：
文献类型：
--
作者：
Asaria, Miqdad;Ali, Shehzad;Cookson, Richard
背景提供全民覆盖对于实现医疗保健公平至关重要，但全民医疗保健系统中仍然存在不平等现象。2004/2005年至2011/2012年期间，自1948年以来一直提供全民覆盖的英格兰国家卫生服务体系（NHS）作出了持续努力，通过加强初级保健来减少健康不平等。我们提供了第一次全面评估的社会经济不平等的初级保健的机会，质量和成果在此期间的趋势。方法全人口小面积纵向研究的基础上，约1500人在英格兰的32 482个街区，从2004/2005年至2011/2012年。我们测量了四个指标的不平等的斜率指数：（1）每个家庭医生的病人，（2）初级保健质量，（3）可预防的急诊入院率和（4）死亡率从条件被认为是适合healthcare.Results之间2004/2005和2011/2012，有较大的绝对改善，在更贫困的社区的所有指标。英格兰最贫困和最贫困社区之间的差距缩小了：每名家庭医生193名病人（95% CI 173至213），初级保健质量的3.29个百分点（3.13至3.45），每千人0.42例可预防住院（0.29至0.55），每千人0.23例可治愈死亡（0.15至0.31）。到2011/2012年，初级保健供应和质量的不平等几乎消除，但社会经济不平等仍然与158396可预防的住院和37983死亡适合healthcare.Conclusions在2004/2005和2011/2012之间，NHS成功地大大减少了初级保健获得和质量的社会经济不平等，但医疗保健结果不平等仅略有减少。
Background Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/2005 and 2011/2012, the National Health Service (NHS) in England, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period.Methods Whole-population small area longitudinal study based on 32 482 neighbourhoods of approximately 1500 people in England from 2004/2005 to 2011/2012. We measured slope indices of inequality in four indicators: (1) patients per family doctor, (2) primary care quality, (3) preventable emergency hospital admissions and (4) mortality from conditions considered amenable to healthcare.Results Between 2004/2005 and 2011/2012, there were larger absolute improvements on all indicators in more-deprived neighbourhoods. The modelled gap between the most-deprived and least-deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% CI 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1000 people (0.29 to 0.55) and 0.23 amenable deaths per 1000 people (0.15 to 0.31). By 2011/2012, inequalities in primary care supply and quality were almost eliminated, but socioeconomic inequality was still associated with 158 396 preventable hospitalisations and 37 983 deaths amenable to healthcare.Conclusions Between 2004/2005 and 2011/2012, the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality, but made only modest reductions in healthcare outcome inequalities.