Short and long-term inequity in outpatient medical use by the type of medical institutions in Korea

Abstract Background Many countries agree with the horizontal equity that medical resources should be allocated according to medical needs, regardless of income. Although the short-term equity index calculated through cross-sectional data doesn't reflect the dynamics of individual income and medical use, it can be supplemented by the long-term equity index using panel data. Koreans tend to choose expensive but highly specialized services without considering their medical needs because they are free to choose service providers. This study aims to empirically examine how the patterns of outpatient medical use that are not based on medical needs differ in terms of short- and long-term equity for each type of medical institution. Methods Using Korea Health Panel Survey(2014-2018), the equity of outpatient medical use(number of visits, medical expenses) of 10,244 people was measured by type of medical institution (tertiary general hospital, general hospital, hospital, clinic, and dentist). Wagstaff&van Doorslaer(2000)’s tool and Jones & Lopez-Nicolas(2004)’s tool were used to calculate the short and long-term horizontal equity index(HI), and mobility index(MI) to compare short and long-term inequity. Results In tertiary general hospitals and dentists, there were short and long-term pro-rich inequalities(HI > 0, p < 0.05). As a result of comparison, long-term inequality was greater in the number of visits (MI < 0), while inequality was easing in the long-term in medical expenses(MI > 0) in tertiary general hospitals. In dentists, long-term inequality was less than short-term inequality in both the number of visits and medical expenses (MI > 0). Conclusions The short-term equity index is likely to underestimate or overestimate inequity in our society, so a long-term perspective is needed. Inequality patterns for each type of medical institution should be considered in healthcare reforms for fair distribution of medical resources. Key messages • Short-term equity index differs from the long-term equity index in outpatient medical use. • The pattern of short and long-term equity indices may differ by type of medical institutions.


Objective:
To construct an individual socioeconomic status index (ISESI) with information available in the Population Information System of the Region of Valencia, Spain, and use it to analyse inequalities in a colorectal cancer screening programme (CRCSP).

Methods:
Cross-sectional study. The study population was composed of men and women aged between 50 and 69 who were invited to participate in the most recently completed round of the Region of Valencia CRCSP in 2020, n = 1,150,684. A multiple correspondence analysis was performed to aggregate information in the Segmented, Integrated and Geographical Population Analysis Code from the Population Information System of the Region of Valencia into an ISESI. Data from the 2016 Region of Valencia Health Survey was used for validation. The relationship between CRCSP participation and the ISESI was analysed by logistic regression models.

Results:
The variables included in the index were nationality, employment status, disability, healthcare coverage, risk of vulnerability and family size. The most important categories for determining the highest socioeconomic status were being employed and not being at risk of social vulnerability, and being unemployed and at risk of social vulnerability for determining the lowest socioeconomic status. Index validation demonstrated internal and external coherence for measuring socioeconomic status. The relationship between CRCSP participation and the ISESI categorised by quartile (Q) showed that Q4 (the lowest socioeconomic status) was less likely to participate OR = 0.769 (0.757-0.782) than Q1 (the highest socioeconomic status), and the opposite was found for Q2 OR = 1.368 (1.347-1.390) and Q3 OR = 1.156 (1.137-1.175).

Conclusions:
An ISESI was constructed and validated using Population Information System data and made it possible to evaluate inequalities in colorectal cancer screening.

Key messages:
An individual socioeconomic status index was constructed and validated using Regional Population Information System data. The Individual socioeconomic status index constructed allows to systematically evaluates inequalities in colorectal cancer screening.
Abstract citation ID: ckac131.109 Short and long-term inequity in outpatient medical use by the type of medical institutions in Korea

Background:
Many countries agree with the horizontal equity that medical resources should be allocated according to medical needs, regardless of income. Although the short-term equity index calculated through cross-sectional data doesn't reflect the dynamics of individual income and medical use, it can be supplemented by the long-term equity index using panel data. Koreans tend to choose expensive but highly specialized services without considering their medical needs because they are free to choose service providers. This study aims to empirically examine how the patterns of outpatient medical use that are not based on medical needs differ in terms of short-and long-term equity for each type of medical institution.

Methods:
Using Korea Health Panel Survey(2014-2018), the equity of outpatient medical use(number of visits, medical expenses) of 10,244 people was measured by type of medical institution (tertiary general hospital, general hospital, hospital, clinic, and dentist). Wagstaff&van Doorslaer (2000)'s tool and Jones & Lopez-Nicolas(2004)'s tool were used to calculate the short and long-term horizontal equity index(HI), and mobility index(MI) to compare short and long-term inequity.

Results:
In tertiary general hospitals and dentists, there were short and long-term pro-rich inequalities(HI > 0, p < 0.05). As a result of comparison, long-term inequality was greater in the number of visits (MI < 0), while inequality was easing in the long-term in medical expenses(MI > 0) in tertiary general hospitals. In dentists, long-term inequality was less than short-term inequality in both the number of visits and medical expenses (MI > 0).

Conclusions:
The short-term equity index is likely to underestimate or overestimate inequity in our society, so a long-term perspective is needed. Inequality patterns for each type of medical institution should be considered in healthcare reforms for fair distribution of medical resources. Key messages: Short-term equity index differs from the long-term equity index in outpatient medical use. The pattern of short and long-term equity indices may differ by type of medical institutions.