Top

International Journal of Public Health

Published in:

01-03-2018 | Original Article

Inequalities in the utilization of health care services in a transition European country: results from the national population health survey

Authors: Janko Janković, Sladjana Šiljak, Miloš Erić, Jelena Marinković, Slavenka Janković

Published in: International Journal of Public Health | Issue 2/2018

Abstract

Objectives

To examine demographic, socio-economic, and health status inequalities in the utilization of health care services (UHCS) in the Republic of Srpska (RS), Bosnia and Herzegovina.

Methods

Data were retrieved from the 2010 National Health Survey for the RS adult population (n = 4128). A complex sample design was taken into account for statistical analysis.

Results

As compared to men, a higher percentage of women visited a family physician (FP), urgent care department, dentist and private doctor. Higher educated women and those worse-off (OR 1.17) more frequently visited FP. Hospitalization (OR 4.56 for males; OR 9.17 for females), visit to urgent care department (OR 3.19 for males; OR 2.42 for females) and visits to FP in females (OR 1.46) were associated with poor self-perceived health. No inequalities by wealth index were found for the utilization of FP, hospitalization, urgent care and dentist among persons with poor self-perceived health status.

Conclusions

The present study confirmed demographic, socio-economic and health status inequalities in the UHCS in RS. These findings have significant implications for health policy makers that seek to provide equal care for all people living in RS.

Allin S, Masseria C, Mossialos E (2009) Measuring socioeconomic differences in use of health care services by wealth versus by income. Am J Public Health 99:1849–1855CrossRefPubMedPubMedCentral

Arcaya MC, Arcaya AL, Subramanian SV (2015) Inequalities in health: definitions, concepts, and theories. Glob Health Action 8:27106. doi:10.3402/gha.v8.27106 CrossRefPubMed

Bahramian H, Mohebbi S, Khami MR, Asadi-Lari M, Shamshiri AR, Hessari H (2015) Psychosocial determinants of dental service utilization among adults: results from a population-based survey (Urban HEART-2) in Tehran. Iran. Eur J Dent 9:542–550CrossRefPubMed

Balabanova D, McKee M, Pomerleau J, Rose R, Haerpfer C (2004) Health service utilization in the former soviet union: evidence from eight countries. Health Serv Res 39(6 Pt 2):1927–1950. doi:10.1111/j.1475-6773.2004.00326.x CrossRefPubMedPubMedCentral

Bertakis KD, Azari R, Lj Helms, Callahan EJ, Robbins JA (2000) Gender differences in the utilization of health care services. BMC J Fam Pract 49:147–152

Borrell C, Rue M, Pasarín MI, Rohlfs I, Ferrando J, Fernandez E (2000) Trends in social class inequalities in health status, health-related behaviours and health services utilization in a Southern European urban area (1983–1994). Prev Med 31:691–701CrossRefPubMed

Borrell C, Fernandez E, Schiaffino A, Benach J, Rajmil L, Villalbi JR, Segura A (2001) Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance? Int J Qual Health Care 13:117–125CrossRefPubMed

Braveman P (2006) Health disparities and health equity: concepts and measurement. Annu Rev Public Health 27:167–194CrossRefPubMed

Cain J, Duran A, Fortis A, Jakubowski E (2002) In: Cain J, Jakubowski E (eds.) Heath care systems in transition: Bosnia and Herzegovina. Copenhagen: European Observatory on Health Care Systems 4(7): 39–54

Christian B, Chattopadhyay A, Kingman A, Boroumand S, Adams A, Garcia I (2013) Oral health care services utilisation in the adult US population: medical Expenditure Panel Survey 2006. Community Dent Health 30:161–167PubMed

CSDH (Commission on Social Determinants of Health) (2008) Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the CSDH, Geneva, WHO. http://www.who.int/social_determinants/thecommission/finalreport/en/. Accessed 30 Sep 2016

Fan L, Shah MN, Veazie PJ, Friedman B (2011) Factors associated with emergency department use among the rural elderly. J Rural Health 27:39–49CrossRefPubMedPubMedCentral

Filc D, Davidovich N, Novack L, Balicer RD (2014) Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health 13:115. doi:10.1186/s12939-014-0115-1 CrossRefPubMedPubMedCentral

Garrido-Cumbrera M, Borrell C, Palència L, Espelt A, Rodríguez-Sanz M, Pasarín MI, Kunst A (2010) Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system. Int J Health Serv 40:525–542CrossRefPubMed

George PP, Heng BH, De Castro Molina JA, Wong LY, Wei Lin NC, Cheah JT (2012) Self-reported chronic diseases and health status and health service utilization-results from a community health survey in Singapore. Int J Equity Health 11:44. doi:10.1186/1475-9276-11-44 CrossRefPubMedPubMedCentral

Habicht J, Kiivet R, Habicht T, Kunst A (2009) Social inequalities in the use of health care services after 8 years of reforms—a comparative study of the Baltic Countries. Int J Public Health 54:250–259CrossRefPubMed

Hansen AH, Halvorsen PA, Ringberg U, Førde OH (2012) Socio-economic inequalities in health care utilisation in Norway: a population based cross-sectional survey. BMC Health Serv Res 12:336. doi:10.1186/1472-6963-12-336 CrossRefPubMedPubMedCentral

Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O et al (2012) Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 41(3):871–886CrossRefPubMedPubMedCentral

Janković J, Simić S, Marinković J (2010) Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia. Eur J Public Health 20:389–396CrossRefPubMed

Janković S, Stojisavljević D, Janković J, Erić M, Marinković J (2014) Status of cardiovascular health in a transition European country: findings from a population-based cross-sectional study. Int J Public Health 59:769–778CrossRefPubMed

Jatrana S, Crampton P (2009) Gender differences in general practice utilisation in New Zealand. J Prim Health Care 1:261–269

Kawachi I, Subramanian SV, Almeida-Filho N (2002) A glossary for health inequalities. J Epidemiol Community Health 56:647–652CrossRefPubMedPubMedCentral

Ladwig KH, Marten-Mittag B, Formanek B, Dammann G (2000) Gender differences of symptoms reporting and medical health care utilisation in the German population. Eur J Epidemiol 16:511–518CrossRefPubMed

Makinen M, Waters H, Rauch M, Almagambetova N, Bitran R, Gilson L, McIntyre D, Pannarunothai S, Prieto AL, Ubilla G, Ram S (2000) Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition. Bull WHO 78:55–65PubMedPubMedCentral

Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P (2012) WHO European review of social determinants of health and the health divide. Lancet 380:1011–1029CrossRefPubMed

Ministry of Health and Social Welfare of the Republic of Srpska (2006) The primary health care strategy in the Republic of Srpska. Ministry of Health and Social Welfare of the Republic of Srpska, Banja Luka. https://www.mindbank.info/item/2662. Accessed 30 Sep 2016

Moorin R, Homan C (2006) The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogeneous health status. BMC Health Serv Res 6:74–78. doi:10.1186/1472-6963-6-74 CrossRefPubMedPubMedCentral

Morris S, Sutton M, Gravelle H (2005) Inequity and inequality in the use of health care in England: an empirical investigation. Soc Sci Med 60:1251–1266CrossRefPubMed

Mumcu G, Sur H, Yildirim C, Soylemez D, Atli H, Hayran O (2004) Utilisation of dental services in Turkey: a cross-sectional survey. Int Dent J 54:90–96CrossRefPubMed

Pappa E, Niakas D (2006) Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res 6:146. doi:10.1186/1472-6963-6-146 CrossRefPubMedPubMedCentral

Parslow R, Jorm A, Christensen H, Jacomb P, Rodgers B (2004) Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med 59:2121–2129CrossRefPubMed

Pavi E, Karampli E, Zavras D, Dardavesis T, Kyriopoulos J (2010) Social determinants of dental health services utilisation of Greek adults. Community Dent Health 27:145–150PubMed

Piperno A, Di Orio F (1990) Social differences in health and utilisation of health services in Italy. Soc Sci Med 31:305–312CrossRefPubMed

Redondo-Sendino A, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F (2006) Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health 6:155. doi:10.1186/1471-2458-6-155 CrossRefPubMedPubMedCentral

Regidor E, Martínez D, Calle ME, Astasio P, Ortega P, Domínguez V (2008) Socioeconomic patterns in the use of public and private health services and equity in health care. BMC Health Serv Res 8:183. doi:10.1186/1472-6963-8-183 CrossRefPubMedPubMedCentral

Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ (1996) Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol 49:989–995CrossRefPubMed

Ross CE, Wu C (1995) The links between education and health. Am Sociol Rev 60:719–745CrossRef

Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA (2011) Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 61(582):e12–e21CrossRefPubMed

Starfield B (2007) Pathways of influence on equity in health. Soc Sci Med 64:1355–1362CrossRefPubMed

Stirbu I, Kunst AE, Mielck A, Mackenbach JP (2011) Inequalities in utilisation of general practitioner and specialist services in 9 European Countries. BMC Health Serv Res 11:288 http://www.biomedcentral.com/1472-6963/11/288. Accessed 30 Sep 2016

Van Doorslaer E, Masseria C, Koolman X (2006) Inequalities in access to medical care by income in developed countries. CMAJ 174:177–183CrossRefPubMedPubMedCentral

van Oostrom SH, Picavet HS, de Bruin SR, Stirbu I, Korevaar JC, Schellevis FG, Baan CA (2014) Multimorbidity of chronic diseases and health care utilization in general practice. BMC Fam Pract 15:61. doi:10.1186/1471-2296-15-61 CrossRefPubMedPubMedCentral

Walters S, Suhrcke M (2005) Socioeconomic inequalities in health and health care access in central and eastern Europe and the CIS: a review of the recent literature. Copenhagen, WHO Regional Office for Europe, 2005 (WHO European Office for Investment for Health and Development Working Paper 2005/1). http://www.euro.who.int/_data/assets/pdf_file/0006/125457/e94412.pdf

Whitehead M, Dahlgren G (2006) Concepts and principles for tackling social inequities in health: Levelling up Part 1. WHO. http://www.euro.who.int/_data/assets/pdf_file/0010/74737/E89383. Accessed 30 Sep 2016

Title: Inequalities in the utilization of health care services in a transition European country: results from the national population health survey
Authors: Janko Janković
Sladjana Šiljak
Miloš Erić
Jelena Marinković
Slavenka Janković
Publication date: 01-03-2018
Publisher: Springer International Publishing
Published in: International Journal of Public Health / Issue 2/2018
Print ISSN: 1661-8556
Electronic ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-017-1009-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Inequalities in the utilization of health care services in a transition European country: results from the national population health survey

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2018

Water system unreliability and diarrhea incidence among children in Guatemala

Social vulnerability as a predictor of physical activity and screen time in European children

Predicting homeless people’s perceived health after entering the social relief system in The Netherlands

Towards a national child and adolescent health strategy in Switzerland: strengthening surveillance to improve prevention and care

Differences in the risk of cardiovascular disease for movers and stayers in New Zealand: a survival analysis

Childhood adversities and chronic conditions: examination of mediators, recall bias and age at diagnosis