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首页> 外文期刊>BMC Health Services Research >The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status
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The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status

机译：社会经济状况，服务可及性和患者类型对西澳大利亚州医院使用的影响：对具有同等健康状况的患者进行的回顾性队列研究

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Background This study aimed to investigate groups of patients with a relatively homogenous health status to evaluate the degree to which use of the Australian hospital system is affected by socio-economic status, locational accessibility to services and patient payment classification. Method Records of all deaths occurring in Western Australia from 1997 to 2000 inclusive were extracted from the WA mortality register and linked to records from the hospital morbidity data system (HMDS) via the WA Data Linkage System. Adjusted incidence rate ratios of hospitalisation in the last, second and third years prior to death were modelled separately for five underlying causes of death. Results The independent effects of socioeconomic status on hospital utilisation differed markedly across cause of death. Locational accessibility was generally not an independent predictor of utilisation except in those dying from ischaemic heart disease and lung cancer. Private patient status did not globally affect utilisation across all causes of death, but was associated with significantly decreased utilisation three years prior to death for those who died of colorectal, lung or breast cancer, and increased utilisation in the last year of life in those who died of colorectal cancer or cerebrovascular disease. Conclusion It appears that the Australian hospital system may not be equitable since equal need did not equate to equal utilisation. Further it would appear that horizontal equity, as measured by equal utilisation for equal need, varies by disease. This implies that a 'one-size-fits-all' approach to further improvements in equity may be over simplistic. Thus initiatives beyond Medicare should be devised and evaluated in relation to specific areas of service provision.
机译：背景技术本研究旨在调查健康状况相对均一的患者群体，以评估澳大利亚医院系统的使用受到社会经济状况，服务的位置可及性和患者付款分类的影响程度。方法从西澳州死亡率登记表中提取西澳大利亚州1997年至2000年（含）期间发生的所有死亡记录，并通过西澳州数据链接系统将其与医院发病率数据系统（HMDS）的记录相关联。分别针对五个潜在的死亡原因对死亡前最后，第二和第三年住院调整后的发病率比率进行建模。结果社会经济状况对医院利用率的独立影响因死亡原因而有显着差异。除因缺血性心脏病和肺癌死亡的患者外，位置可达性通常不是利用率的独立预测指标。私人患者的状况并没有全局影响所有死亡原因的利用率，但与死于大肠癌，肺癌或乳腺癌的患者的利用率在死亡前三年显着降低，以及那些在生命的最后一年中利用率提高的患者有关死于大肠癌或脑血管疾病。结论由于平等的需求并不等于平等的利用，澳大利亚的医院制度似乎并不公平。进一步看来，以平等利用，平等需求衡量的横向公平因疾病而异。这意味着进一步提高公平性的“一刀切”的方法可能过于简单。因此，应针对服务提供的特定领域设计和评估医疗保险之外的举措。

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