This Article Immediate free access via SAGE Open OA Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Manderbacka, K. Articles by Keskimäki, I. Search for Related Content PubMed PubMed Citation Articles by Manderbacka, K. Articles by Keskimäki, I. Social Bookmarking                         What's this?

Change and persistence in healthcare inequities: Access to elective surgery in Finland in 1992—2003

Health Services Research, STAKES (National Research and Development Centre for Welfare and Health), Helsinki, Finland, kristiina.manderbacka{at}stakes.fi

Martti Arffman

Health Services Research, STAKES (National Research and Development Centre for Welfare and Health), Helsinki, Finland

Alastair Leyland

MRC Social and Public Health Science Unit, Glasgow, UK

Alison Mccallum

NHS Lothian Health Board, Edinburgh, UK

Ilmo Keskimäki

Health Services Research, STAKES (National Research and Development Centre for Welfare and Health), Helsinki, Finland

Aims: Many countries experience persistent or increasing socioeconomic disparities in specialist care. This study examines the socioeconomic distribution of elective surgery from 1992 to 2003 in Finland. Methods: Administrative registers were used to identify common elective procedures performed in all public and private hospitals in Finland in 1992—2003. Patients' individual sociodemographic data came from 1990—2003 census and employment statistics databases. First coronary revascularisation, hip and knee replacement, lumbar disc operation, cataract extraction, hysterectomy and prostatectomy on residents aged 25—84 years were analysed. Age-standardized procedure rates by income quintile were calculated for both genders, and concentration indices were developed and applied to age-standardized procedure rates in 5% income groups for each study year. Results: Most procedure rates increased during the study period. Three trends emerged: declining inequality for coronary revascularisations, an increase and then a decline in cataract extractions and primary knee replacements among men, and positive relationships between income and treatment for hysterectomy and lumbar disc operations. Conclusions: Our results suggest that structural features — uneven availability, co-payments and plurality of provision — sustain inequity in access; decreasing inequities reflect directed service expansion. Increased attention to collective, prospective funding of primary and specialist ambulatory care is required to increase equity of access to elective surgery.

Key Words: Elective surgery • health services research • hospital use • socioeconomic equity

References

• van Doorslaer E., Masseria C., Koolman X., for the OECD Health Equity Research Group. Inequalities in access to medical care by income in developed countries. CMAJ 2006;174:177-83.[Abstract/Free Full Text]
• Keskimaöki I. How did Finland's economic recession in the early 1990s affect socio-economic equity in the use of hospital care? Soc Sci Med 2003;56:1517-30.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Hetemaa T., Keskimaöki I., Manderbacka K., Leyland AH, Koskinen S. How did the recent increase in the supply of coronary operations in Finland affect socio-economic and gender equity in their use? J Epidemiol Community Health 2003;57:178-85.[Abstract/Free Full Text]
• Milner PC, Payne JN, Stanfield RC, Lewis PA, Jennison C., Saul C. Inequalities in accessing hip joint replacement for people in need. Eur J Public Health 2004;14:58-62.[Abstract/Free Full Text]
• Yong PF, Milner PC, Payne JN, Lewis PA, Jennison C. Inequalities in access to knee joint replacements for people in need. Ann Rheum Dis 2004;63:1483-9.[Abstract/Free Full Text]
• Alter DA, Naylor CD, Austin P., Tu JV Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med 1999;341:1359-67.[Abstract/Free Full Text]
• Morris RW, Whincup PH, Papacosta O., Walker M., Thomson A. Inequalities in coronary revascularisation during the 1990s: evidence from the British regional heart study. Heart 2005;91:635-40.[Abstract/Free Full Text]
• Finnish Heart Association. Suomen sydaöntutkimus- ja toimenpiderekisteri 2003 [Register for coronary examinations and procedures 2003]. The Finnish Heart Association. 2005 (in Finnish).
• Finnish Hospital League. Toimenpidenimikkeistoö 1983 [Classification of procedures 1983]. Helsinki, 1983 (in Finnish).
• Nomesco Classification of surgical procedures. Copenhagen: NOMESCO, 1996.
• Kakwani N., Wagstaff A., van Doorslaer E. Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics 1997; 77:87-103.[CrossRef]
• van Doorslaer E., Wagstaff A., Bleichrodt H., Calonge S., Gerdtham UG, Gerfin M., et al. Income-related inequalities in health: some international comparisons. J Health Economics 1997;16:93-112.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Salmela R., Koistinen V. Yleissairaaloiden poistoilmoitusrekisterin kattavuus ja luotettavuus [Is the discharge register of general hospitals complete and reliable?]. Sairaala 1987;49:480-2 (in Finnish).
• Keskimaöki I., Aro S. Accuracy of data on diagnosis, procedures and accidents in the Finnish Hospital Discharge Register. Int J Health Sci 1991;2:15-21.
• Maöhoönen M., Salomaa V., Brommels M., Molarius A., Miettinen H., Pyoöraölaö K., et al. The validity of hospital discharge register data on coronary heart disease in Finland. Eur J Epidemiol 1997;13:403-15.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pajunen P., Koukkunen H., Ketonen M., Jerkkola T., Immonen-Raöihaö P., Karja-Koskenkari P., et al. The validity of the Finnish Hospital Discharge Register and Causes of Death Register data on coronary heart disease. Eur J Cardiovasc Prev Rehabil 2005;12:132-7.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Aromaa A, Koskinen S, editors. Health and functional capacity in Finland. Baseline results of the Health 2000 health examination survey. Publications of the National Public Health Institute. Helsinki, 2004.
• Asada Y. A framework for measuring health inequity. J Epidemiol Community Health 20005;59:700-5.
• van Doorslaer E., Masseria C., OECD Health Equity Research Group. Income-related inequality in the use of medical care in 21 OECD countries. In: The OECD Health Project. Towards high-performing health systems. Paris: OECD; 2004, 109-66.
• Haökkinen U. Cost containment in Finnish health care. In: Mossialos E, Le Grand J, editors. Health care and cost containment in the European Union. Aldershot: Ashgate, 1999, 661-99.
• Koivusalo M. Decentralisation and equity of healthcare provision in Finland. BMJ 1999;318:1198-1200.[Free Full Text]
• Ng J., Morlet N., Semmens J. Socioeconomic and rural differences for cataract surgery in Western Australia. Clin Exp Ophthalmol 2006;34:317-23.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Productivity Commission. Advances in medical technology in Australia. Research Report. Melbourne; 2005.
• Hawker GA, Wright JG, Glazier RH, Coyte PC, Harvey B., Williams JI, Badley EM The effect of education and income on need and willingness to undergo total joint arthroplasty. Arthritis Rheum 2002;46:3331-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Suomen Laöaökaöriseura Duodecimin ja Suomen Ortopediyhdistys ry:n asettama tyoöryhmaö. [working group set by the Finnish Medical society Duodecim and the Finnish orthopaedic Association]. Polvi-ja lonkkanivelrikon hoito [Current care recommendations. The treatment of osteoarthritis of the knee and the hip]. Duodecim 2007;123:1759-60 (in Finnish).[Medline] [Order article via Infotrieve]
• Fairbank J., Frost H., Wilson-MacDonald J., Yu L-M., Barker K., Collins R., et al. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005;330:1233, doi:10.1136/bmj.38441.620417.BF.[Abstract/Free Full Text]
• Bernstein S., Fiske M., McGlynn E., Gifford D. Hysterectomy. A review of the literature on indications, effectiveness, and risks. Santa Monica: Southern California Health Policy Research Consortium, RAND, 1997.
• McCallum A. Socio-economic differences in use of specialist services in Nordic countries. In: Nomesco, editor. Health Statistics in the Nordic countries 2002. Section B. Equal access to care. Copenhagen: NOMESCO; 2004, 204-22.
• Brouwer W., Hermans H. Private clinics for employees as a Dutch solution for waiting lists: economic and legal arguments. Health Policy 1999;47:1-17.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

This version was published on March 1, 2009

Scandinavian Journal of Public Health, Vol. 37, No. 2, 131-138 (2009)
DOI: 10.1177/1403494808098505


SAGE Open article

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Immediate free access via SAGE Open OA Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Manderbacka, K. Articles by Keskimäki, I. Search for Related Content PubMed PubMed Citation Articles by Manderbacka, K. Articles by Keskimäki, I. Social Bookmarking                         What's this?