md-medicaldata

Authors

 

Slađana Šiljak¹, Janko Janković², Slavenka Janković^3
1Institut za javno zdravstvo Republike Srpske, Republika Srpska, Bosna i Hercegovina
²Institut za socijalnu medicinu, Medicinski fakultet, Univerzitet u Beogradu, Srbija
³Institut za epidemiologiju, Medicinski fakultet, Univerzitet u Beogradu, Srbija

 

• Rad je primljen 21.07.2016. / Prihvaćen 10.08.2016.

 

Correspondence to:
Dr sc med. Slađana Šiljak
Jovana Dučića 1, 78 000 Banja Luka,
+387 65 856 617,
e-mail: sladjanaps@gmail.com

 

Abstract

 

Introduction. Inequalities in hospitalization and emergency care exist all over the world. The aim of this study was to investigate demographic, socio-economic, lifestyle and health status inequalities in hospitalization and emergency care (EC) in Republic of Srpska (RS), Bosnia and Herzegovina.
Methods. This study is a part of 2010 National Health Survey for the population of RS. A total of 4673 persons age ≥18 years were identified in households and 4128 were interviewed. Bivariate and multivariate logistic regression analyses were used to assess the influence of different variables on the utilization of hospitalization and emergency care services.
Results. As compared with men, women visited hospital less frequently [odds ratio (OR) = 0.69; 95% confidence interval (95% CI) = 0.50–0.95]. No inequalities by social class were observed neither for hospital utilization nor for EC. Patients with chronic diseases (NCD) compared to those without these conditions more often visited hospitals (OR = 3.18; 95% CI = 2.45–4.13) and EC (OR = 2.05; 95% CI = 1.57–2.67). Persons with NCD and good physicial activity less frequently visited hospital than physical inactive persons, but those who self-perceived their health as a good were less likely to have visited a hospital and EC than those with poor health.
Conclusion. This study has shown that demographic, socio-economic, lifestyle and health status inequalities in the pattern of hospitalization and EC services exist in RS. Reducing inequalities in the utilization of health services in RS is a public health policy priority for future.

 

 

Key words

health service utilization, hospitalization, emergency care services, health survey, inequalities in health, Republic of Srpska

 

 

References

 

1. Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman l. Impact of socioeconomic status on hospital use in New York City. Health Affairs 1993.12(1):162-173. Available from http://content.healthaffairs.org/content/12/1/162.full.pdf+html. Accessed April 16, 2016
2. Rose LL, Walld R, Uhanova J, Bond R. Physician Visits, Hospitalizations, and Socioeconomic Status: Ambulatory Care Sensitive Conditions in a Canadian Setting. HSR: Health Services Research 2005.40:4.
3. Jiménez-Rubio, D., Smith, P. C. and Van Doorslaer, E. Equity in health and health care in a decentralised context: evidence from Canada. Health Econ.2008;17:377–392
4. Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. American Journal of Public Health. 1997;87(5):811-816. Accessed April 24, 2016
5. Vasquez F, Paraje G, Estay M. Income-related inequality in health and health care utilization in Chile, 2000-2009. Rev Panama Salud Publica 2013;33(2):98-106
6. Van der Heyden S, Demarest J, Tafforeau H, et al. Socioeconomic differences in the utilization of health services in Belgium. Health Policy 2003;65:153-165.
7. Margaret J, Penning and Chi Zheng. Income Inequities in Health Care Utilization among Adults Aged 50 and Older. Canadian Journal on Aging 35:55-69. doi:10.1017/S0714980815000562.
8. Veugelers PJ, Yip AM. Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health? J Epidemiol Community Health 2003;57:424-428. 
9. Masseria C, Giannoni M. Equity in access to health care in Italy: a disease-based approach. European Journal of Public Health 2010;20(5):504-510. Available from http://eurpub.oxfordjournals.org/content/eurpub/20/5/504.full.pdf. Accessed April 16, 2016
10. Filc et al.: Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? International Journal for Equity in Health 2014;13:115.
11. Pappa E, Niakas D. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res 2006;6:146.
12. Jankovic J, Simic S, Marinkovic J. Inequalities that hurt: demographic, socio-economic and health status inequalities in the utilization of health services in Serbia. Eur J Public Health 2010; 20:389-396.
13. Allin S, Masseria C, Mossialos E. Equity in health care use among older people in the UK: an analysis of panel data. Applied Economics 2011;43:2229–2239
14. Fernandez de la Hoz K, Leon DA. Self-perceived health status and inequalities in use of health services in Spain. Int J Epidemiol 1996;25:593-603.
15. Redondo Sendino A, Castillon Guallar P, Banegas JR, Rodriguez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health 2006;6:155. Available from: URL: http://www.biomedcentral.com/1471-2458/6/155/. Accessed April 16, 2016.
16. Bachmann MO, Eachus J, Hopper CD, et al. Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med 2003;20:921-929. Available from: URL: http://onlinelibrary.wiley.com/doi/10.1046/j.1464-5491.2003.01050.x/abstract. Accessed April 16, 2016 
17. Dray-Spira R, Gary TL, Brancati FL. Socioeconomic Position and Cardiovascular Disease in Adults with and without Diabetes: United States Trends, 1997–2005. J Gen Intern Med 2008;23:1634-1641.
18. Ministarstvo zdravlja i socijalne zaštite Republike Srpske. Strategija primarne zdravstvene zaštite u Republici Srpskoj. Ministarstvo zdravlja i socijalne zaštite Republike Srpske 2006. Available from: URL: (http://www.vladars.net/Servisi_Gradjani_Dokumenti/Strategija%20primarne%20zdravstvene%20zastite.pdf). Accessed April 16, 2016
19. Zakon o zdravstvenoj zaštiti. Službeni Glasnik Republike Srpske broj 106/09. 
20. Zakon o izmjenama i dopunama Zakona o zdravstvenoj zaštiti. Službeni Glasnik Republike Srpske broj 44/15. 
21. Rutstein SO, Johnson K. The DHS Wealth Index. DHS Comparative Reports No.6.Calverton, Maryland: ORC Macro; 2004. Available from: http://www.childinfo.org/files/DHS_Wealth_Index_%28DHS_Comparative_Reports%29.pdf Accessed April 16, 2016
22. Fernandez E, Schiaffino A, Rajmil L, et al. Gender inequalities in health and health care services use in Catalonia (Spain). J Epidemiol Community Health 1999;53:218-222. Available from: URL: http://jech.bmj.com/content/53/4/218.full.pdf+html. Accessed April 16, 2016
23. Asada Y, Kephart G. Equity in health services use and intensity of use in Canada. BMC Health Serv Res 2007;7:41. (cited 2013 February 03).Available from: URL: http://www.biomedcentral.com/1472-6963/7/41. 
24. Blackwell D, Matinez ME, Gentleman JF, et al. Socioeconomic Status and Utilization of Health Care Services in Canada and the United States: Findings From a Binational Health Survey. Medical Care 2011;47:1136-1146. Available from: URL: http://journals.lww.com/lwwmedicalcare/Abstract/2009/11000/Socioeconomic_Status_and_Utilization_of_Health.5.aspx. Accessed April 16, 2016
25. Izumi Y, Tsuji I, Ohkubo T, et al. Impact of smoking habit on medical care use and its costs: a prospective observation of National Health Insurance beneficiaries in Japan. Int J Epidemiol 2001;30:616-621. Available from: URL: http://ije.oxfordjournals.org/content/30/3/616.full.pdf+html. Accessed April 16, 2016 
26. Rodríguez Artalejo F, de Andrés Manzano B, Guallar-Castillón P, et al. The association of tobacco and alcohol consumption with the use of health care services in Spain. Prev Med 2000;31:554-561.
27. Travis CB, Meltzer AL, Howerton DM. Gender issues in health care utilization. In: Chrisler JC, McCreary DR,eds. Handbook of Gender Research in Psychology. New York: Springer 2010;517-540 
28. Mian O, Pong R. Does better access to FPs decrease the likelihood of emergency department use? Can Fam Physician 2012;58:658-666. Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498040/. Accessed June 12, 2016
29. Bertakis KD, Azari R. Obesity and the use of health care services. Obes Res 2005;13:372-379.  Available from: URL: http//:www.onlinelibrary.wiley.com/doi/10.1038/oby.2005.49/pdf. Accessed Jun18, 2016
30. Reidpath DD, Crawford D, Tilgner L, et al. Relationship between body mass index and the use of healthcare services in Australia. Obes Res 2002;10:526-31
31. Fan L, Shah MN, Veazie P, et al. Factors Associated with Emergency Department Use among the Rural Elderly. J Rural Health 2011;27:39-49. Available from: URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058487/. Accessed June 12, 2016
32. Zuckermann S, Shen Y. Characteristics of Occasional and Frequent Emergency Department Users: Do Insurance Coverage and Access to Care Matter. Med Care 2004;42:176-182.  Available from: URL: http://journals.lww.com/lww-medicalcare/Abstract/2004/02000/Characteristics_of_Occasional_and_Frequent.11.aspx.   
33. Borrell C, Fernandez E, Schiaffino A, et al. 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 2001;13:117–25.

UDK: 616-082(497.6)
616-083.98(497.6)
COBISS.SR-ID 226168076

PDF Šiljak S. et al • MD-Medical Data 2016;8(3): 195-202