TY - JOUR
T1 - Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system
AU - Tayyari Dehbarez, Nasrin
AU - Gyrd-Hansen, Dorte
AU - Uldbjerg, Niels
AU - Søgaard, Rikke
N1 - Funding Information:
This study was funded by the Central Denmark Region Health Research Fund, Aarhus University and the Health Foundation (Danish) (grant number 15-B-0122 ).
Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/7
Y1 - 2018/7
N2 - Equity of access to health care is a central objective of European health care systems. In this study, we examined whether free choice of hospital, which has been introduced in many systems to strengthen user rights and improve hospital competition, conflicts with equity of access to highly specialized hospitals. We chose to carry out a study on 134,049 women who had uncomplicated pregnancies from 2005 to 2014 in Denmark because of their homogeneity in terms of need, the availability of behavioral data, and their expected engagement in choice of hospital. Multivariate logistic regression was used to link the dependent variable of bypassing the nearest non-highly specialized public hospital in order to “up-specialize” with independent variables related to socioeconomic status, risk attitude, and choice premises, using administrative registries. Overall, 16,426 (12%) women were observed to bypass the nearest hospital to up-specialize. Notably, high education level was significantly associated with up-specialization, with an odds ratio of 1.50 (95% CI: 1.40–1.60, p < 0.001) compared to low education group. This confirms our hypothesis that there is a socioeconomic gradient in terms of exercising the right to a free choice of hospital, and so the results indicate that the policy exacerbates inequity of access to health care.
AB - Equity of access to health care is a central objective of European health care systems. In this study, we examined whether free choice of hospital, which has been introduced in many systems to strengthen user rights and improve hospital competition, conflicts with equity of access to highly specialized hospitals. We chose to carry out a study on 134,049 women who had uncomplicated pregnancies from 2005 to 2014 in Denmark because of their homogeneity in terms of need, the availability of behavioral data, and their expected engagement in choice of hospital. Multivariate logistic regression was used to link the dependent variable of bypassing the nearest non-highly specialized public hospital in order to “up-specialize” with independent variables related to socioeconomic status, risk attitude, and choice premises, using administrative registries. Overall, 16,426 (12%) women were observed to bypass the nearest hospital to up-specialize. Notably, high education level was significantly associated with up-specialization, with an odds ratio of 1.50 (95% CI: 1.40–1.60, p < 0.001) compared to low education group. This confirms our hypothesis that there is a socioeconomic gradient in terms of exercising the right to a free choice of hospital, and so the results indicate that the policy exacerbates inequity of access to health care.
KW - Denmark
KW - Horizontal equity
KW - Hospital choice
KW - Risk attitude
KW - Socioeconomic status
UR - http://www.scopus.com/inward/record.url?scp=85046117891&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2018.04.006
DO - 10.1016/j.healthpol.2018.04.006
M3 - Journal article
C2 - 29706507
AN - SCOPUS:85046117891
SN - 0168-8510
VL - 122
SP - 722
EP - 727
JO - Health Policy
JF - Health Policy
IS - 7
ER -