Journal Information
Vol. 20. Issue 5.
Pages 352-359 (September - October 2006)
Vol. 20. Issue 5.
Pages 352-359 (September - October 2006)
Originales
Open Access
Asociación de los ingresos económicos con la utilización y la accesibilidad de los servicios sanitarios en España al inicio del siglo XXI
Association of income with use of and access to health services in Spain at the beginning of the XXI century
Visits
998
Enrique Regidor
Corresponding author
enriqueregidor@hotmail.com

Correspondencia: Dr. Enrique Regidor Departamento de Medicina Preventiva y Salud Pública. Facultad de Medicina. Universidad Complutense de Madrid. Ciudad Universitaria, s/n. 28040 Madrid. España.
, David Martínez, Paloma Astasio, Paloma Ortega, María Elisa Calle, Vicente Domínguez
Departamento de Medicina Preventiva y Salud Pública, Universidad Complutense de Madrid, España
This item has received

Under a Creative Commons license
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumen
Objetivo

Estimar la asociación de los ingresos económicos del hogar y de la renta provincial con las consultas al medico general y al especialista y con la hospitalización. Estimar si el tiempo de espera para acceder a esos servicios varía con esas características.

Método

Datos de la Encuesta Nacional de Salud de 2001. La asociación se estimó mediante la odds ratio, ajustada por edad y sexo, y en el caso de la renta per cápita se ajustó también por los ingresos económicos del hogar. Se estimaron los percentiles y la media geométrica de los tiempos de espera en cada servicio sanitario y se evaluó la significación estadística de su asociación con ambas variables económicas.

Resultados

Los sujetos con menores ingresos económicos presentan la mayor frecuencia de consultas al médico general y hospitalización, aunque esperan más tiempo para ser hospitalizados. Estos sujetos presentan la menor frecuencia de consultas al especialista: la odds ratio en el cuartil más bajo de ingresos frente al más alto fue 0,73 (intervalo de confianza del 95%, 0,62-0,87), aunque en las consultas financiadas públicamente la menor frecuencia se observa en los sujetos con mayores ingresos. No se han encontrado diferencias en la utilización y en los tiempos de espera según la renta provincial.

Conclusiones

La frecuencia de consultas al especialista según los ingresos económicos del hogar muestra un patron distinto al observado en las consultas al médico general y en la hospitalización. El mayor tiempo de espera para hospitalización se observa en los sujetos con menores ingresos económicos.

Palabras clave:
Servicios sanitarios
Utilización
Accesibilidad a los servicios sanitarios
Ingresos económicos
Abstract
Objective

To estimate the association of household income and provincial income with visits to general practitioners and specialists and with hospitalization and to determine whether waiting times to access these services vary with both economic variables.

Method

Data from the 2001 National Health Survey were used. The association was estimated by sex- and age-adjusted odds ratios; in the case of per capita income, odds ratios were also adjusted for household income. Percentiles and the geometric mean of waiting times in each health service were estimated and the statistical significance of their association with both economic variables was evaluated.

Results

Subjects with the lowest household income showed the highest frequency of visits to general practitioners and hospitalization, although they waited longer for hospital admission. Subjects with the lowest household income also showed the lowest frequency of specialist visits: the odds ratio in the lowest income quartile with respect to the highest income quartile was 0.73 (95% CI: 0.62-0.87). However, when only visits to specialists working in the public system were analyzed, the lowest frequency of visits was observed in subjects with the highest household income. No differences were found in health services utilization or in waiting times according to provincial income.

Conclusions

The frequency of specialist visits according to household income shows a different pattern from that observed for visits to general practitioners and hospitalizations. The longest waiting times for admission to hospital were observed in subjects with the lowest household income.

Key words:
Health services
Utilization
Access to health care
Income
Full text is only aviable in PDF
Bibliografía
[1.]
M. Benzeval, K. Judge, M. Whitehead.
The roel of the NHS.
Tackling inequalities in health. An agenda for action,
[2.]
M. Whitehead, M. Evandrou, B. Haglund, F. Diderichsen.
As the health divide widens in Sweden and Britain, what's happening to access to care?.
BMJ, 315 (1997), pp. 1006-1009
[3.]
J.P. Mackenbach.
The contribution of medical care to mortality decline: McKeown revisited.
J Clin Epidemiol, 49 (1996), pp. 1207-1213
[4.]
H. Tunstall-Pedoe, D. Vanuzo, M. Hobbs, M. Mahonen, Z. Cepaitis, K. Kuulasmaa, et al.
Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations.
Lancet, 355 (2000), pp. 688-700
[5.]
S. Capewell, R. Beaglehole, M. Seddon, J. McMurray.
Explanation for the Decline in Coronary Heart Disease Mortality Rates in Auckland, New Zealand, Between 1982 and 1993.
Circulation, 102 (2000), pp. 1511-1516
[6.]
R. Peto, J. Boreham, M. Clarke, C. Davies, V. Beral.
UK and USA breast cancer deaths down 25% in year 2000 at ages 20-69 years.
[7.]
Health inequalities. Decennial supplement,
[8.]
J.P. Mackenbach, V. Bos, O. Andersen, M. Cardano, G. Costa, S. Harding, et al.
Widening socioeconomic inequalities in mortality in six European countries.
Int J Epidemiol, 32 (2003), pp. 830-837
[9.]
A.E. Kunst, V. Bos, E. Lahelma, M. Bartley, I. Lissau, E. Regidor, et al.
Trends in socio-economic inequalities in self assessed health in ten European countries.
Int J Epidemiol, 34 (2005), pp. 295-305
[10.]
E. Regidor, S. De Mateo, J.L. Gutiérrez-Fisac, K. Fernández de la Hoz, C. Rodríguez.
Diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en España.
Med Clin (Barc), 107 (1996), pp. 285-288
[11.]
K. Fernández de la Hoz, D. Leon.
Self-perceived health status and inequalities in use of health services in Spain.
Int J Epidemiol, 25 (1996), pp. 593-693
[12.]
C. Borrell, I. Rohlfs, J. Ferrando, M.I. Pasarín, F. Domínguez Berjón, A. Plasencia.
Social inequalities in perceived health and the use of health services in a southern European urban area.
Int J Health Serv, 29 (1999), pp. 743-764
[13.]
L. Lostao, E. Regidor, M.E. Calle, P. Navarro, V. Domínguez.
Evolución de las diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en España entre 1987 y 1995/1997.
Rev Esp Salud Pública, 75 (2001), pp. 115-128
[14.]
B. Buhmann, L. Rainwater, G. Schmauss, T. Smeeding.
Equivalence scales, well-being, inequality and poverty: sensitivity estimates across 10 countries using the LIS database.
Rev Income Wealth, 34 (1988), pp. 115-142
[15.]
M.J. Catalán-Reyes, MP. Galindo-Villardon.
Utilización de los modelos multinivel en investigación sanitaria.
Gac Sanit, 17 (2003), pp. 35-52
[16.]
A. Díez Roux.
Multilevel análisis in public health.
Ann Rev Public Health, 21 (2000), pp. 193-221
[17.]
E. Regidor, P. Navarro, V. Domínguez, C. Rodríguez.
Inequalities in income and longterm disability in the regions of Spain: analysis of recent hypotheses with a crosssectional study based on individual data.
BMJ, 315 (1997), pp. 11306
[18.]
R. Ecob, G. Davey Smith.
Income and health: what is the nature of the relationship?.
Soc Sci Med, 48 (1999), pp. 693-705
[19.]
V. Pedrera, V. Gil, D. Orozco, I. Prieto, G. Schwarz, I. Moya.
Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana.
Aten Primaria, 35 (2005), pp. 82-88
[20.]
M. Sáez.
Condicionantes en la utilización de los servicios de atención primaria. Evidencias empíricas e inconsistencias metodológicas.
Gac Sanit, 17 (2003), pp. 412-419
[21.]
S. Frankel, S. Ebrahim, G. Davey Smith.
The limits to demand for health care.
BMJ, 321 (2000), pp. 40-45
[22.]
R. Penchansky, J.W. Thomas.
The concept of access: definition and relationships to consumer satisfaction.
Med Care, 19 (1981), pp. 127-140
[23.]
C. Isanta, P. Rivera, M. Pedraja, N. Jiménez.
Características de las personas que acuden a las consultas de demanda del centro de salud sin cita previa.
Rev Esp Salud Pública, 74 (2000), pp. 263-274
[24.]
I. Keskimäki, S. Kosjkinen, M. Salinto, S. Aro.
Socioeconomic and gender inequities in access to coronary artery bypass grafting in Finland.
Eur J Public Health, 7 (1997), pp. 393-397
[25.]
A. Britton, M. Shipley, M. Marmot, H. Hemingway.
Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study ?.
BMJ, 329 (2004), pp. 18-323
[26.]
A. Oliver, E. Mossialos.
Equity of access to health care: outlining the foundations for action.
J Epidemiol Community Health, 58 (2004), pp. 655-658
Copyright © 2006. Sociedad Española de Salud Pública y Administración Sanitaria
Download PDF
Idiomas
Gaceta Sanitaria
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?