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Inequalities in the utilisation of primary and specialist physicians in Europe - a systematic review
(2019)
Background: The evidence on inequalities in health clearly shows that people with lower socioeconomic status (SES) have poorer health and higher mortality. Nevertheless, generalized evidence for inequalities in healthcare is lacking. So far, the international literature was only summarised with regard to inequalities in the utilisation of disease-specific treatment. Therefore, our aim was to synthetize the literature on socioeconomic inequalities in the utilisation of primary and specialist physicians in the general population.
Methods: This systematic review searched Medline und Web of Science from 2004 to 2018. Articles that reported quantitative data on the association of SES with utilisation of primary or specialist physicians in Europe were included. Title and abstract screening were performed by two independent researchers and 50 full texts are currently sifted whether they fulfil the inclusion criteria.
Results: The studies analysed utilisation of physicians in terms of probability or frequency. The initial check of the studies indicates that socioeconomic inequalities in the utilisation of physicians differ between primary and specialist care. Specialist physicians were found to be visited with a higher probability and more often by the least disadvantaged in most studies. Inequalities in the utilisation of primary physicians revealed to be more diverse with a weak pattern of equally distributed probability of GP visits and more frequent utilisation by the disadvantaged.
Conclusions: The preliminary results indicate that pro-rich utilisation seems to be more pronounced in visiting specialists compared to primary health care. Aiming to reduce inequalities in healthcare, public health actions might primarily focus on reaching a needs-based consultation of specialist physicians.
Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review
(2021)
Background
Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries.
Methods
We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria.
Results
Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES.
Conclusion
This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare.
Hintergrund: „Health Behaviour in School-aged Children (HBSC)“ ist eine der größten internationalen Kinder- und Jugendgesundheitsstudien und kooperiert mit der Weltgesundheitsorganisation (WHO). In Deutschland werden im vierjährigen Turnus jeweils Heranwachsende im Alter von 11, 13 und 15 Jahren zur Gesundheit, zum Gesundheitsverhalten und zu sozialen Rahmenbedingungen befragt. Der Beitrag widmet sich der Beschreibung der HBSC-Studie und speziell der Methodik des aktuellen Surveys 2022 sowie der vorherigen Erhebungen von 2009/10 bis 2017/18. Methode: Am Survey 2022 beteiligten sich 174 Schulen mit insgesamt 6.475 Schülerinnen und Schülern. Die Erhebung erfolgte mittels Fragebogen und erfasst ein breites Themenspektrum (u. a. mentale Gesundheit, Bewegungsverhalten, Mobbingerfahrungen, soziale Determinanten der Gesundheit sowie Erfahrungen im Zusammenhang mit COVID-19). Ergänzt wurde die Erhebung 2022 um eine Schulleitungsbefragung (N = 160). Neben der aktuellen Stichprobe werden auch die Stichproben der vorangegangenen drei Surveys mit repräsentativen Angaben für Deutschland vorgestellt: 2009/10 (N = 5.005), 2013/14 (N = 5.961) und 2017/18 (N = 4.347). Diskussion: Die Kinder- und Jugendgesundheit hat eine hohe Public-Health-Relevanz. Dazu leistet die HBSC-Studie einen elementaren Beitrag, denn sie liefert international vergleichbare Ergebnisse, ermöglicht die Analyse von
Trendentwicklungen und stellt umfangreiche, repräsentative Daten zum Gesundheitsmonitoring für Stakeholder bereit.
Background: Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18.
Method: 174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347).
Discussion: The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.
Hintergrund: Viele Studien berichten von gesundheitlichen Ungleichheiten im Kindes- und Jugendalter. Unklar ist, wie sich diese in den letzten Jahren, insbesondere vor dem Hintergrund der COVID-19-Pandemie, entwickelt haben. Methode: Die Analysen basieren auf den deutschen Daten der internationalen HBSC-Studie (Health Behaviour in Schoolaged Children) von 2009/10 (n = 5.005), 2013/14 (n = 5.961), 2017/18 (n = 4.347) und 2022 (n = 6.475). Insgesamt wurden 21.788 Schülerinnen und Schüler im Alter von ca. 11 bis 15 Jahren berücksichtigt. Der sozioökonomische Status (SES) wurde mithilfe der Family Affluence Scale (FAS) erhoben. Verschiedene Gesundheitsindikatoren wurden mittels bi- und multivariaten Analysemethoden stratifiziert nach Geschlecht ausgewertet. Ergebnisse: 2022 zeigen sich deutliche sozioökonomische Ungleichheiten in der Lebenszufriedenheit, der subjektiven Gesundheit, im Obst- und Gemüsekonsum sowie im Bewegungsverhalten. Diese Ungleichheiten sind im Zeitverlauf von 2009/10 bis 2022 überwiegend konstant geblieben oder haben sich vergrößert. Zwischen 2017/18 und 2022 sind keine signifikanten Änderungen bezüglich der betrachteten Ungleichheiten zu erkennen. Schlussfolgerungen: Gesundheitliche Ungleichheiten zeigen sich kontinuierlich und reduzieren die Chancen auf ein gesundes Aufwachsen. Es gibt keine Hinweise darauf, dass sich die Ungleichheiten während des Pandemie-Zeitraums (zwischen 2017/18 und 2022) verändert haben. Die Veränderungen in den betrachteten Gesundheitsindikatoren betreffen vielmehr alle Heranwachsende in ähnlicher Weise.
Background: Many studies have identified health inequalities in childhood and adolescence. However, it is unclear how these have developed in recent years, particularly since the COVID-19 pandemic.
Methods: Analyses are based on the German data from the international Health Behaviour in School-aged Children (HBSC) study from 2009/10 (n = 5,005), 2013/14 (n = 5,961), 2017/18 (n = 4,347), and 2022 (n = 6,475). A total of 21,788 students aged approximately between 11 and 15 years were included. Socioeconomic status (SES) was assessed using the Family Affluence Scale (FAS). Several health indicators were analysed stratified by gender using bivariate and multivariate analysis methods.
Results: In 2022, there are clear socioeconomic inequalities in life satisfaction, self-rated health, fruit and vegetable consumption, and physical activity. These inequalities remained largely constant or increased between 2009/10 and 2022. Between 2017/18 and 2022, no significant changes in inequalities were found.
Conclusions: Health inequalities are persistent and reduce the chances of growing up healthy. There is no evidence that inequalities in the analysed outcomes have changed during the pandemic period (between 2017/18 and 2022). Rather, the changes in the health indicators seem to affect all adolescents in a similar way.