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Evolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditions

2017-08-16Artigo científico Acesso aberto
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dc.contributor.authorDimitrovová, Klára
dc.contributor.authorCosta, Cláudia
dc.contributor.authorSantana, Paula
dc.contributor.authorPerelman, Julian
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.pblBioMed Central (BMC)
dc.date.accessioned2018-02-07T23:11:40Z
dc.date.available2018-02-07T23:11:40Z
dc.date.issued2017-08-16
dc.description.abstractBackground: Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) are specific conditions for which hospitalization is thought to be avoidable through patient education, health promotion initiatives, early diagnosis and by appropriate chronic disease management, and have been shown to be greatly influenced by socioeconomic (SE) characteristics. We examined the SE inequalities in hospitalization rates for ACSC in Portugal, their evolution over time (2000-2014), and their associated financial burden. Methods: We modeled municipality-level ACSC hospitalization rates per 1000 inhabitants and ACSC hospitalization-related costs per inhabitant, for the 2000-2014 period (n = 4170), as a function of SE indicators (illiteracy and purchasing power, in quintiles), controlling for the proportion of elderly, sex, disease specific mortality rate, population density, PC supply, and time trend. The evolution of inequalities was measured interacting SE indicators with a time trend. Costs attributable to ACSC related hospitalization inequalities were measured by the predicted values for each quintile of the SE indicators. Results: Hospitalization rate for ACSC was significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 1.97; p < 0.01), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 1.19; p < 0.05). ACSC hospitalization-related costs were also significantly higher in the 4th quintile of illiteracy compared with the 1st quintile (beta = 4.04€; p < 0.05), and significantly lower in the 5th quintile of purchasing power, compared with the 1st quintile (beta = - 4,69€; p < 0.01). The SE gradient significantly increased over the 2000-2014 period, and the annual cost of inequalities were estimated at more than 15 million euros for the Portuguese NHS. Conclusion: There was an increasing SE patterning in ACSC related hospitalizations, possibly reflecting increasing SE inequalities in early and preventive high-quality care, imposing a substantial financial burden to the Portuguese NHS.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent11
dc.format.extent704302
dc.identifier.doi10.1186/s12939-017-0642-7
dc.identifier.issn1475-9276
dc.identifier.otherPURE: 3198070
dc.identifier.otherPURE UUID: 17828c2a-9d8d-4b28-95d7-d180323fa288
dc.identifier.otherScopus: 85027516523
dc.identifier.otherWOS: 000407835700001
dc.identifier.otherPubMed: 28810869
dc.identifier.urihttp://www.scopus.com/inward/record.url?scp=85027516523&partnerID=8YFLogxK
dc.identifier.urlhttps://www.scopus.com/pages/publications/85027516523
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAmbulatory care sensitive conditions
dc.subjectCosts
dc.subjectPrimary care
dc.subjectSocioeconomic inequalities
dc.subjectHealth Policy
dc.subjectPublic Health, Environmental and Occupational Health
dc.subjectSDG 3 - Good Health and Well-being
dc.titleEvolution and financial cost of socioeconomic inequalities in ambulatory care sensitive conditionsen
dc.title.subtitlean ecological study for Portugal, 2000-2014en
dc.typejournal article
degois.publication.issue1
degois.publication.titleInternational Journal for Equity in Health
degois.publication.volume16
dspace.entity.typePublication
rcaap.rightsopenAccess

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