Exploring equity in accessing diabetes management treatment

A healthcare gap analysis

Bibliographic Data

ID4593096
AuthorsIna Tapager (0000-0002-7375-7288, University of Copenhagen, corresponding author), Kenneth R Olsen (0000-0002-0473-4736, University of Southern Denmark), Karsten Vrangbæk (0000-0002-5850-2367, University of Copenhagen)
Year2022
Volume292
Pages114550
Publication date2022-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2021.114550
PMID34837828
OpenAlexW3214705865
LanguageEN
Citations received2
References cited36

Healthcare inequities are often investigated empirically as associations between socio-economic characteristics and differences between observed healthcare utilisation and estimates of needs-based utilisation. However, the concept of 'need' is tricky to operationalise and utilisation may be contingent on inequities arising at an earlier stage. In this study, we apply a unique combination of register and survey data collected in 2019 to assess equity in opportunities to access treatment for patients with recently diagnosed type 2 diabetes. In the study of this population (N = 1864) we escape the challenge of estimating needs by arguing that need can be approximated from treatment guidelines within a nationwide framework of disease management programmes. Furthermore, instead of observed utilisation we use patient reports on whether they have been offered treatment as a measure of opportunities to access multiple components of care, that is, we focus on possible inequalities arising prior to possible utilisation inequalities. 'Healthcare gaps' are computed as the discrepancy between an index of guideline recommended treatments and patients' perceived offers of treatments, thus providing a novel take on the 'healthcare deprivation profiles' approach to the study of healthcare inequalities. Using this method, we explore and document inequalities along multiple dimensions of familiar socio-economic factors (income, education, occupation) as well as self-reported barriers to access. We also provide supporting evidence that healthcare gaps, as measured in our study, are associated with poorer quality of care, and that those who experience large gaps are more likely to be disadvantaged in terms of self-reported difficulties in relation to key self-care aspects. We conclude that even in a health system with comprehensive universal coverage, healthcare inequity can arise already at the stage of offering access to preventive treatment. The results warrant further research into the causes, consequences and remedies of such inequities

Business · Diabetes mellitus · Economic growth · Economics · Equity (law · Health care · Health equity · Political science · Public health · Chronic Disease Management Strategies · Diabetes Management and Education · Medicine · Nursing · Primary Care and Health Outcomes

Tools

Open DOIOpen Access