Health care institutions and inequalities in health care utilisation in young people

在分析卫生和社会经济方面的不平等时，必须考虑到卫生保健系统，其主要目的是确保提供良好和公平的卫生保健。卫生保健利用率是一个常用的绩效指标，当社会经济不平等的重点。早在儿童和青少年时期，就可以看到保健利用方面的社会经济不平等现象。虽然国家/宏观层面的特点对卫生保健利用的影响一直是科学研究的主题，但迄今为止，较低层面（卫生保健系统的中观层面）的因素一直被忽视。此外，这一中间水平几乎没有具体的定义。我们确定了医疗保健系统的中观层面的三个维度，患者与之互动，并介导/调节儿童的社会经济地位（SEP）和他们的医疗保健利用之间的关系：的尺寸（区域）获取、提供服务的层面，分别是提供服务的程度、质量和连续性（假设这些在很大程度上受到医生的影响），最后是卫生政策方面。在此背景下，子项目SP 6探讨了以下研究问题：1。个人层面的决定因素是否有助于解释青年人的医疗保健使用不公平现象，哪些物质、心理和行为因素对解释青年人与社会经济相关的医疗保健使用不公平现象的相对贡献最大？2.社会人口学和社会经济学特征是否影响儿童和青少年对卫生保健服务的使用？3.卫生保健系统中与获得服务有关的中观层面的哪些特征导致了与收入有关的卫生保健使用不平等？4.社会经济地位高和低的儿童是否经历了不同的医疗保健服务，医疗保健系统的中间层次是否发挥了作用？5.作为鼓励父母带子女进行预防性体检的提醒计划（德语：“Früherkennungsuntersuchungen”），卫生保健系统中间一级的卫生政策是否与儿童和青少年的卫生保健利用有关？根据对最新证据的范围审查，次级方案6将分析来自“德国儿童和青少年健康访谈和检查调查”的数据以及来自德国法定健康保险的保险索赔数据。分析方法包括回归模型（问题1、2）、分解分析（问题3）、确定和分析卫生保健提供的模式、过程和途径（问题4）以及准实验方法（问题5）。

When analysing health and socioeconomic inequities in health, consideration must inevitably turn to the health care system, whose predominant purpose is to ensure good and fair health care provision. Health care utilization is a commonly used performance measure, when socioeconomic inequities is focused upon. Socioeconomic inequities in health care utilization are visible as early as in childhood and adolescence. While the influence of state/macro-level characteristics on health care utilization have been subject of scientific research, factors on a lower level, the meso-level of the health care system, have been neglected so far. Additionally, this intermediary level has been scarcely defined in concrete terms. We identified three dimensions of the health care system’s meso-level, with which the patient interacts, and that mediates/moderates the relationship between children’s socioeconomic position (SEP) and their health care utilization: the dimension of (regional) access, the dimension of provision, respectively the extent, quality and continuity of provision (assuming that these are influenced by the physician to a significant degree) and, lastly, the dimension of health policy. Against this background, subproject SP 6 investigates the following research questions:1. Do individual-level determinants contribute to the explanation of health care use inequities in young people and which material, psychosocial and behavioural factors show the strongest relative contribution for the explanation of socioeconomic related health care use inequities among young people?2. Do sociodemographic and socioeconomic characteristics influence the use of health care services in childhood and adolescence?3. Which of the meso-level characteristics of the health care system related to access account for income-related inequity in health care use?4. Do children with high and low socioeconomic position experience a different provision of health care services and does the meso-level of the health care system play a role?5. Are health policies at the meso-level of the health care system, as the reminder scheme to encourage patents to bring their children to preventive medical check-ups (German: “Früherkennungsuntersuchungen”), associated with the health care use of children and adolescents?Based on a scoping review of the most recent evidence, SP6 will analyse data from the “German Health Interview and Examination Survey for Children and Adolescents” (KiGGS) and insurance claims data from German statutory health insurances. Analytical Methods include regression models (question 1, 2), decomposition analyses (question 3), identification and analysis of patterns, processes and pathways in the health care provision (question 4) and quasi-experimental methods (question 5).