Educational inequalities in mortality amenable to healthcare. A comparison of European healthcare systems
Rydland, Hâvard T. (Norwegian University of Science and Technology (NTNU))
Fjær, Erlend L. (Norwegian University of Science and Technology (NTNU))
Eikemo, Terje A. (Erasmus MC)
Huijts, Tim (Maastricht University)
Bambra, Clare (Newcastle University)
Wendt, Claus (University of Siegen)
Kulhánová, Ivana (Erasmus MC)
Martikainen, Pekka (University of Helsinki)
Dibben, Chris (University of Edinburgh)
Kalėdienė, Ramuné (Lithuanian University of Health Sciences)
Borrell i Thió, Carme (Institut d'Investigació Biomèdica Sant Pau)
Leinsalu, Mall (National Institute for Health Development)
Bopp, Matthias (University of Zürich)
Mackenbach, J.P (Erasmus MC)
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3. 57; SII = 414) and female (RII = 3. 18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1. 78; male SII = 123; female RII = 1. 86; female SII = 78. 5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	PloS one, Vol. 15 Núm. 7 (july 2020) , p. e0234135, ISSN 1932-6203

DOI: 10.1371/journal.pone.0234135
PMID: 32614848

17 p, 806.8 KB

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