Despite free public healthcare, Italy's poor are more likely to end up in hospital with avoidable conditions, new research shows. This pattern, reported today in the online open access journal BMC Public Health, mirrors findings from a number of different healthcare systems around the world, although to date fewer studies have been completed in Europe.
A research team led by Nera Agabiti at the Department of Epidemiology, ASL RM/E Rome (Italy) used hospital discharge data from the year 2000 from Rome, Bologna, Turin and Milan. They focussed on patients with six chronic conditions: diabetes, hypertension (without procedures), congestive heart failure (without procedures), angina pectoris (without procedures), chronic obstructive pulmonary disease (COPD), and asthma. These ambulatory care sensitive conditions (ACSCs) are disorders where hospitalisation is potentially preventable with the right care and medication. Hospitalisation rates for ACSCs are also increasingly used as an indicator of primary health care (PHC) efficacy.
The researchers found a statistically significant socio-economic gradient for all medical conditions they investigated. The association was particularly strong for COPD and congestive heart failure, where the poorest had around four times the risk of hospitalisation compared with the well off. Except for asthma, males were more vulnerable to ACSC hospitalisation than females, and the risk increased for those aged 45-64 compared to younger age groups.
"This study provides evidence of higher rates of hospitalisation for ACSC for economically disadvantaged people in Italy, where barriers to health care are not expected to exist because of the universal health care system. This finding highlights the need for improving outpatient care programmes to reduce the excess of unnecessary hospitalisations among poor people," says Agabiti, adding: "Low socio-economic individuals are vulnerable and tend to receive substandard care."
- Nera Agabiti, Monica Pirani, Patrizia Schifano, Giulia Cesaroni, Marina Davoli, Luigi Bisanti, Nicola Caranci, Giuseppe Costa, Francesco Forastiere, Chiara Marinacci, Antonio Russo, Teresa Spadea, Carlo A. Perucci and Italian Study Group on Inequalities in Health Care Isgihc. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy. BMC Public Health, 2009; (in press) [link]
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