Limits...
Is utilization of health services for HIV patients equal by socioeconomic status? Evidence from the Basque country.

García-Goñi M, Nuño-Solinís R, Orueta JF, Paolucci F - Int J Equity Health (2015)

Bottom Line: HIV prevalence per 1000 individuals is greater the lower the socioeconomic status (0.784 for highest; 2.135 for lowest), for males (1.616) versus females (0.729), and for middle-age groups (26-45 and 46-65).Health expenditures are 11826€ greater for HIV patients than for others, but with differences by socioeconomic group derived from a different mix of services utilization (total cost of 13058€ for poorest, 14960€ for richest).We recommend establishing accurate clinical guidelines with the appropriate mix of health provision by validated need for all socioeconomic groups; promoting educational programs so that patients demand the appropriate mix of services, and stimulating integrated care for HIV patients with multiple chronic conditions.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Madrid, Spain. mggoni@ucm.es.

ABSTRACT

Introduction: Access to ART and health services is guaranteed under universal coverage to improve life expectancy and quality of life for HIV patients. However, it remains unknown whether patients of different socioeconomic background equally use different types of health services.

Methods: We use one-year (2010-2011) data on individual healthcare utilization and expenditures for the total population (N = 2262698) of the Basque Country. We observe the prevalence of HIV and use OLS regressions to estimate the impact on health utilization of demographic, socioeconomic characteristics, and health status in such patients.

Results: HIV prevalence per 1000 individuals is greater the lower the socioeconomic status (0.784 for highest; 2.135 for lowest), for males (1.616) versus females (0.729), and for middle-age groups (26-45 and 46-65). Health expenditures are 11826€ greater for HIV patients than for others, but with differences by socioeconomic group derived from a different mix of services utilization (total cost of 13058€ for poorest, 14960€ for richest). Controlling for health status and demographic variables, poor HIV patients consume more on pharmaceuticals; rich in specialists and hospital care. Therefore, there is inequity in health services utilization by socioeconomic groups.

Conclusions: Equity in health provision for HIV patients represents a challenge even if access to treatment is guaranteed. Lack of information in poorer individuals might lead to under-provision while richer individuals might demand over-provision. We recommend establishing accurate clinical guidelines with the appropriate mix of health provision by validated need for all socioeconomic groups; promoting educational programs so that patients demand the appropriate mix of services, and stimulating integrated care for HIV patients with multiple chronic conditions.

No MeSH data available.


Related in: MedlinePlus

Total health expenditures and prevalence ratio by socioeconomic groups
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4625850&req=5

Fig1: Total health expenditures and prevalence ratio by socioeconomic groups

Mentions: Table 3 presents the average cost for HIV patients by provider and SEG. The cost on ART, by construction, has been considered to be identical for all individuals. Primary care and pharmaceutical prescriptions are more used by poorer individuals while hospitalization and specialist care are more used by richest individuals. Precisely, those are the most expensive types of health provision without taking ART into account. Consequently, the Basque Country allocates a greater amount of public health resources in HIV patients in the richest SEG (14960€) while it allocates lower resources in HIV patients in the poorest SEG (13058€), and lowest for the third SEG (12585€). Figure 1 crosses the prevalence ratio and average total health expenditures for the five socioeconomic groups. While prevalence is negatively related to socioeconomic status (lower prevalence for richer SEG), total health expenditures for HIV patients is highest for the richest SEG and the trend of both series seems to be opposite. Figure 2 shows the proportion of HIV patients with different numbers of comorbidities by SEG. Even if there are some differences, the distribution of chronic conditions is similar in each SEG and for the total HIV population having about 76 % of them at least another chronic condition.Table 3


Is utilization of health services for HIV patients equal by socioeconomic status? Evidence from the Basque country.

García-Goñi M, Nuño-Solinís R, Orueta JF, Paolucci F - Int J Equity Health (2015)

Total health expenditures and prevalence ratio by socioeconomic groups
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625850&req=5

Fig1: Total health expenditures and prevalence ratio by socioeconomic groups
Mentions: Table 3 presents the average cost for HIV patients by provider and SEG. The cost on ART, by construction, has been considered to be identical for all individuals. Primary care and pharmaceutical prescriptions are more used by poorer individuals while hospitalization and specialist care are more used by richest individuals. Precisely, those are the most expensive types of health provision without taking ART into account. Consequently, the Basque Country allocates a greater amount of public health resources in HIV patients in the richest SEG (14960€) while it allocates lower resources in HIV patients in the poorest SEG (13058€), and lowest for the third SEG (12585€). Figure 1 crosses the prevalence ratio and average total health expenditures for the five socioeconomic groups. While prevalence is negatively related to socioeconomic status (lower prevalence for richer SEG), total health expenditures for HIV patients is highest for the richest SEG and the trend of both series seems to be opposite. Figure 2 shows the proportion of HIV patients with different numbers of comorbidities by SEG. Even if there are some differences, the distribution of chronic conditions is similar in each SEG and for the total HIV population having about 76 % of them at least another chronic condition.Table 3

Bottom Line: HIV prevalence per 1000 individuals is greater the lower the socioeconomic status (0.784 for highest; 2.135 for lowest), for males (1.616) versus females (0.729), and for middle-age groups (26-45 and 46-65).Health expenditures are 11826€ greater for HIV patients than for others, but with differences by socioeconomic group derived from a different mix of services utilization (total cost of 13058€ for poorest, 14960€ for richest).We recommend establishing accurate clinical guidelines with the appropriate mix of health provision by validated need for all socioeconomic groups; promoting educational programs so that patients demand the appropriate mix of services, and stimulating integrated care for HIV patients with multiple chronic conditions.

View Article: PubMed Central - PubMed

Affiliation: Departamento de Economía Aplicada II, Universidad Complutense de Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Madrid, Spain. mggoni@ucm.es.

ABSTRACT

Introduction: Access to ART and health services is guaranteed under universal coverage to improve life expectancy and quality of life for HIV patients. However, it remains unknown whether patients of different socioeconomic background equally use different types of health services.

Methods: We use one-year (2010-2011) data on individual healthcare utilization and expenditures for the total population (N = 2262698) of the Basque Country. We observe the prevalence of HIV and use OLS regressions to estimate the impact on health utilization of demographic, socioeconomic characteristics, and health status in such patients.

Results: HIV prevalence per 1000 individuals is greater the lower the socioeconomic status (0.784 for highest; 2.135 for lowest), for males (1.616) versus females (0.729), and for middle-age groups (26-45 and 46-65). Health expenditures are 11826€ greater for HIV patients than for others, but with differences by socioeconomic group derived from a different mix of services utilization (total cost of 13058€ for poorest, 14960€ for richest). Controlling for health status and demographic variables, poor HIV patients consume more on pharmaceuticals; rich in specialists and hospital care. Therefore, there is inequity in health services utilization by socioeconomic groups.

Conclusions: Equity in health provision for HIV patients represents a challenge even if access to treatment is guaranteed. Lack of information in poorer individuals might lead to under-provision while richer individuals might demand over-provision. We recommend establishing accurate clinical guidelines with the appropriate mix of health provision by validated need for all socioeconomic groups; promoting educational programs so that patients demand the appropriate mix of services, and stimulating integrated care for HIV patients with multiple chronic conditions.

No MeSH data available.


Related in: MedlinePlus