Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary
IntroductionSpatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effecti...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-01-01
|
| Series: | Frontiers in Public Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1152555/full |
| _version_ | 1797347909554929664 |
|---|---|
| author | Feras Kasabji Ferenc Vincze Kinga Lakatos Anita Pálinkás László Kőrösi László Ulicska Karolina Kósa Róza Ádány Róza Ádány János Sándor János Sándor |
| author_facet | Feras Kasabji Ferenc Vincze Kinga Lakatos Anita Pálinkás László Kőrösi László Ulicska Karolina Kósa Róza Ádány Róza Ádány János Sándor János Sándor |
| author_sort | Feras Kasabji |
| collection | DOAJ |
| description | IntroductionSpatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.AimsWe used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.MethodsA cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).ResultsBroad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.ConclusionAdults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks. |
| first_indexed | 2024-03-08T11:55:44Z |
| format | Article |
| id | doaj.art-c30b9dc2581948ee83a508bf9e37cf25 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-08T11:55:44Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-c30b9dc2581948ee83a508bf9e37cf252024-01-24T04:30:03ZengFrontiers Media S.A.Frontiers in Public Health2296-25652024-01-011210.3389/fpubh.2024.11525551152555Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in HungaryFeras Kasabji0Ferenc Vincze1Kinga Lakatos2Anita Pálinkás3László Kőrösi4László Ulicska5Karolina Kósa6Róza Ádány7Róza Ádány8János Sándor9János Sándor10Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryDepartment of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryDepartment of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryNational Health Insurance Fund, Budapest, HungaryDeputy State Secretariat for Social Inclusion, Ministry of Interior, Budapest, HungaryDepartment of Behavioral Sciences, Faculty of Medicine, University of Debrecen, Debrecen, HungaryDepartment of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryDepartment of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryIntroductionSpatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.AimsWe used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.MethodsA cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).ResultsBroad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR = 1.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR = 0.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR = 1.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.ConclusionAdults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.https://www.frontiersin.org/articles/10.3389/fpubh.2024.1152555/fullcross-sectionalsegregationinequalityhealthcarehealth reimbursementgeneral medical practitioner |
| spellingShingle | Feras Kasabji Ferenc Vincze Kinga Lakatos Anita Pálinkás László Kőrösi László Ulicska Karolina Kósa Róza Ádány Róza Ádány János Sándor János Sándor Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary Frontiers in Public Health cross-sectional segregation inequality healthcare health reimbursement general medical practitioner |
| title | Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary |
| title_full | Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary |
| title_fullStr | Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary |
| title_full_unstemmed | Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary |
| title_short | Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary |
| title_sort | cross sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in hungary |
| topic | cross-sectional segregation inequality healthcare health reimbursement general medical practitioner |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1152555/full |
| work_keys_str_mv | AT feraskasabji crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT ferencvincze crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT kingalakatos crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT anitapalinkas crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT laszlokorosi crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT laszloulicska crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT karolinakosa crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT rozaadany crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT rozaadany crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT janossandor crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary AT janossandor crosssectionalcomparisonofhealthcaredeliveryandreimbursementbetweensegregatedandnonsegregatedcommunitiesinhungary |