Inequitable access to public health and healthcare
-
Upload
melanie-rimmer -
Category
Health & Medicine
-
view
396 -
download
2
Transcript of Inequitable access to public health and healthcare
School for Public Health Research 14/12/2015
Inequitable Access
to Public Health and Healthcare
Interventions for Older People: A Scoping
Review
This is an outline of independent research funded by the
National Institute for Health Research’s School for Public Health Research (NIHR SPHR).
The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department
of Health.
Melanie Rimmer1, Nick Payne1, Sarah Salway1, Angie Rees1, Lynne Forrest2,
Stefanie Bucker3
1School for Health and Related Research (ScHARR), The University of Sheffield 2Newcastle University Institute of Health and Society and Fuse 3The University of Cambridge, Cambridge Institute of Public Health
Inequitable Access Project Leads: Yoav Ben-Shlomo, Martin White
School for Public Health Research
Aims of the Review
• To summarise evidence on the extent of age-
related inequity in healthcare access
• To describe and appraise the ‘state of the art’
in terms of research on age-related inequity in
healthcare access
School for Public Health Research
• Healthcare equity can be defined as “equal healthcare
use for equal need”
School for Public Health Research
Methods:
Inclusion Criteria
We searched for papers which:
– Compared older and younger people;
– Looked at any health intervention;
– Had data for use (receipt, access);
– Had data on need.
School for Public Health Research
Methods:
Searching Approach
• Database searching (Medline etc)
• We used a “pearl” of several key papers
• Balance of sensitivity and specificity
School for Public Health Research
Findings:
1. Issues Around Searching
• Sensitivity v Specificity
• Search Medline for “age inequity” in titles – 1 result
• Search for “age” AND “inequit*” in titles – 12 results
• Search for synonyms for age AND inequity - >53,000 results
• Journal indexing (e.g. MeSH), even in gerontology
journals, frequently fails to include a term related to
older people
School for Public Health Research
Findings:
2. Range of Conditions Found
0
5
10
15
20
25
30
35
40
Num
ber
of
papers
School for Public Health Research
Findings:
3. Measures of Need
Socio-
demographic data
Individuals with
diagnosed condition
Population health survey
Mortality data
Disease register
School for Public Health Research
Findings:
4. Measures of Use
• Patient reported
• Routine data
• Survey
• Costing/billing data
• Prescribing data
School for Public Health Research
Findings:
5. Analysis of Use-Need Relationship
• Use:need ratios
• Odds ratios
• Horizontal inequality indices e.g. Gini coefficient or
Concentration Index
School for Public Health Research
Findings:
6. Equity or Inequity?
0
10
20
30
40
50
60
70
Pro-Young Pro-Old No Inequity N/A Other
Num
ber
of
papers
School for Public Health Research
Next Steps
• Identify patterns of inequity e.g. which types of
intervention generate more or less inequities
and how
• Compare geographical locations, types of
service delivery etc
• Explore how research has been framed
14
Gini coefficient
• Gini coefficient measures the extent to which something is inequitably distributed across a population.
• If income were distributed totally evenly across the population, the Cumulative Wealth line (Lorenz curve) would follow the diagonal Equality Line exactly.
• The further below the diagonal the Cumulative Wealth line (Lorenz curve) gets, the less equitable the distribution of income.
• Gini coefficient is = Area A/Area (A + B) Lorenz curve
A
B