Equity in Health Care Prof Sara Willems, MA, PhD Dep. of Family - - PowerPoint PPT Presentation

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Equity in Health Care Prof Sara Willems, MA, PhD Dep. of Family - - PowerPoint PPT Presentation

Jan 08, 2024 351 likes •1.03k views

Equity in Health Care Prof Sara Willems, MA, PhD Dep. of Family Medicine and Primary Health Care Ghent University, Belgium Life expectancy in Belgium increases 2012 2012 total population: 79.65 years male: 76.49 years female: 82.95 years

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Equity in Health Care

Prof Sara Willems, MA, PhD

  • Dep. of Family Medicine and Primary Health Care

Ghent University, Belgium

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Life expectancy in Belgium increases …

2012 2012 total population: 79.65 years male: 76.49 years female: 82.95 years Europe: 75.3 years for men and 81.7 years for women = + 2.7 and +2.3 years from 1998-2010

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… but not for all to the same extent

Life expectancy for men aged 25 according to educational level

54 56 Source: Van Oyen et al, 2010 42 44 46 48 50 52 Higher education Higher secondary education Lower secondary education Primary school degree No degree Number of additional years to live at the age

  • f 25

Educational level

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… but not for all to the same extent

Life expectancy for men aged 25 according to educational level

54 56

Social gradient

Source: Van Oyen et al, 2010 42 44 46 48 50 52 Higher education Higher secondary education Lower secondary education Primary school degree No degree Number of additional years to live at the age

  • f 25

Educational level

Social gradient

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Not all differences in health are inequities in health ! inequalities

Source:

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Not all differences in health are inequities in health

Event Cause Inequity ?

Source:

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity Higher rates of arthritis among elderly compared to children Biological (ageing) No health inequity

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity Higher rates of arthritis among elderly compared to children Biological (ageing) No health inequity Black women having babies with lower birth weight compared to white women Reduced access to medical care Health inequity

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes

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Health inequalities: differences in health status or in the distribution of health (determinants ) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity Higher rates of arthritis among elderly compared to children Biological (ageing) No health inequity Black women having babies with lower birth weight compared to white women Reduced access to medical care Health inequity

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes Sometimes attributable to biological variations or free choice. Ethically or ideologically unacceptable to change/impossible to change SO unavoidable

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity Higher rates of arthritis among elderly compared to children Biological (ageing) No health inequity Black women having babies with lower birth weight compared to white women Reduced access to medical care Health inequity

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes Sometimes attributable to biological variations or free choice. Ethically or ideologically unacceptable to change/impossible to change SO unavoidable

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes Sometimes attributable to biological variations or free choice. Ethically or ideologically unacceptable to change/impossible to change SO unavoidable Others attributable to external environment and conditions outside the control of the individuals concerned Uneven distribution is unnecessary and avoidable, unjust and unfair

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Not all differences in health are inequities in health

Event Cause Inequity ? Severe traffic injury Not wearing seat No health inequity

Source:

Severe traffic injury Not wearing seat belt (individual behaviour) No health inequity Higher rates of sickle cell anemia among blacks Biological (genetics) No health inequity Higher rates of arthritis among elderly compared to children Biological (ageing) No health inequity Black women having babies with lower birth weight compared to white women Reduced access to medical care Health inequity

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes Sometimes attributable to biological variations or free choice. Ethically or ideologically unacceptable to change/impossible to change SO unavoidable Others attributable to external environment and conditions outside the control of the individuals concerned Uneven distribution is unnecessary and avoidable, unjust and unfair

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Health inequalities: differences in health status or in the distribution of health (determinants) between different population groups e.g. differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes Sometimes attributable to biological variations or free choice. Ethically or ideologically unacceptable to change/impossible to change SO unavoidable Others attributable to external environment and conditions outside the control of the individuals concerned Uneven distribution is unnecessary and avoidable, unjust and unfair Health inequities

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Can the healthcare system tackle / contribute to inequity in health?

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Source: B. Starfield, Why health care is important, presentation at Qatar-EMRO Primary Health Care Conference, Doha, Qatar, november 2008

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Source: B. Starfield, Why health care is important, presentation at Qatar-EMRO Primary Health Care Conference, Doha, Qatar, november 2008

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Can the healthcare system tackle / contribute to inequity in health? How can the healthcare system tackle / contribute to inequity in health?

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In order to contribute to health equity, health care should also be equitable

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In order to contribute to health equity, health care should also be equitable

?

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In order to contribute to health equity, health care should also be equitable Equal care for everyone?

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In order to contribute to health equity, health care should also be equitable Equal care for everyone?

E.g. checking blood pressure

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In order to contribute to health equity, health care should also be equitable Equal care for everyone?

E.g. checking blood pressure

Equal care for people in equal need

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Equal care

equal access equal treatments equal outcomes

for people in equal need

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Variations in care

access/treatment/outcomes

because of social mechanisms, structures, processes ~ Inequity in health care

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Equity in health care? The case of Belgium

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Equal health care

equal access equal treatments equal outcomes

for people in equal need

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Financial barriers in access to health care?

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14 16 18 20

Percentage of households that had to postpone medical care because of financial) reasons by educational level, Belgium, 2008

2 4 6 8 10 12 14 Primary or no degree Secondary inferior Secundary superior Superior education

Source: Health Interview Survey 2008, Wetenschappelijk Instituut Volksgezondheid

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Geographical barriers in health care?

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Geographical barriers in health care?

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Geographical barriers in health care?

fdg

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Distribution of care providers ?

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Distribution of care providers ?

10000 Evolution of the number of FTE FP in Belgium (2000-2009) 1 FP /1100 Belgians 2000 4000 6000 8000 10000 2000 2004 2008 2009 Male Female Total

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Distribution of care providers ?

10000 Evolution of the number of FTE FP in Belgium (2000-2009) 1 FP /1100 Belgians 2000 4000 6000 8000 10000 2000 2004 2008 2009 Male Female Total

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Distribution of care providers ?

10000 Evolution of the number of FTE FP in Belgium (2000-2009) 1 FP /1100 Belgians 2000 4000 6000 8000 10000 2000 2004 2008 2009 Male Female Total

  • Increase female FPs
  • Increase part-time FPs
  • Increase FPs in cities
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Equal health care

equal access equal treatments equal outcomes

for people in equal need

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Doctor-patient communication?

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Doctor-patient communication?

Good doctor-patient communication is associated with better patient health and outcomes Is there a variation in doctor-patient communication according to the patient’s SES?

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Systematic literature review (1st 2005 / 2nd 2011) Medline, PsycINFO and Web Of Science 1965 up to now SES: educational level, income or occupation

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Results

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20 relevant papers Variation in doctor-patient communication according to the SES of the patient to the SES of the patient Less involvement in treatment decisions, more directive consultation style, less socio-emotional talk, lower patient control

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Shift in the past 10 years:

  • Doctor-patient communication: emerging topic

(1965-2002: 42 papers, 2002-2011: 87 papers)

  • Emphasis on the reciprocity of communication
  • Growing interest in patients’ perception
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Doctor’s attitude and consultation style?

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Semi-structured interviews with 11 FPs in Flanders Variation of practices

Doctor’s attitude and consultation style?

Variation of practices NVivo analyses

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  • Working with low SES patients takes time, can

be frustrating, but can also be rewarding.

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  • Working with low SES patients takes time, can

be frustrating, but can also be rewarding.

?

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  • Working with low SES patients takes time, can

be frustrating, but can also be rewarding.

  • Handling these kind of feelings seems to vary

according to the number of contacts with patients from lower social classes.

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Occasional contacts: changes in clinical decisions are made in order to enhance the patients outcomes Physicians caring for many low SES people have Physicians caring for many low SES people have difficulties finding the balance between providing good quality of standard care and tailoring the care to the capacities and needs of low SES patients They sometimes have the feeling that the decisions they made are not always in favor of the outcomes for the patient

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Equal health care

equal access equal treatments equal outcomes

for people in equal need

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Equal health care

equal access equal treatments equal outcomes revalidation, …

for people in equal need

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Equity in health care? The case of Europe?

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Equity in health care? The case of Europe?

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Contact: Sara Willems Sara.Willems@ugent.be