IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0194972.html
   My bibliography  Save this article

Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)

Author

Listed:
  • Martina Ventura
  • Danilo Fusco
  • Katia Bontempi
  • Paola Colais
  • Marina Davoli

Abstract

Background: Inequalities in health among groups of various socio-economic status (as measured by education, occupation, and income) constitute one of the main challenges for public health. Since 2006, the Lazio Regional Outcome Evaluation Program (P.Re.Val.E.), presents a set of indicators of hospital performance based on quality standards driven by strong clinical recommendations, and measures the variation in the access to effective health care for different population groups and providers in the Lazio Region. One of the aims of the program was to compare population subgroups in order to promote equity in service provision. Since June 2013, a new management strategy has been put in place that assigned specific goals based on performance assessment to the chief executive officers of the hospitals. Aim: To evaluate whether, in recent years, there has been a reduction in the differential access to effective health care, among individuals with different educational levels. Methods: We enrolled all patients discharged from both public and private hospitals of the Lazio region between 2012 and 2015, living in Lazio region. We analysed the proportion of patients with ST-elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention within 90 minutes (primary PCI), the proportion of patients with hip fracture (HF) who underwent surgery within 2 days, and the proportion of women with primary C-section. We applied multivariate logistic regression models to assess the effect of educational level on health outcomes, adjusting for demographic characteristics and comorbidities that could affect the outcomes. For each year of the study period, we compared adjusted proportions of outcomes for the highest and the lowest level of education by using percentage differences. Results: In the Lazio region, 44.6% of STEMI patients (N = 3,299) were treated with primary PCI, 54.4% of patients with hip fractures (N = 6,602) underwent surgery within 2 days, and 27.7% of women without a previous C-section (N = 34,718) delivered via C-section, in 2015. The corresponding proportions in 2012 were 27.8%, 31.3% and 31.5%, respectively. By comparing the adjusted proportions in patients with the highest education level (a university degree or higher) to those with the lowest level education level (None/Primary school), a decrease in the percentage difference was observed during the study period. In STEMI and delivery cohorts, the improvement of outcomes involved the least and the most educated patients, respectively, and the difference between the two educational levels was close to zero in 2015, whereas for hip patients, the improvement was more evident among the less educated patients. Conclusions: In the Lazio region, we observed a reduction in the differential access to effective heath care by educational level, in different clinical areas. Different factors might explain these results. On top of the public disclosure of outcome data, the management strategy applied in mid-2013 might have driven the overall improvement of the health system for the considered conditions, helping to achieve a fairer access to health.

Suggested Citation

  • Martina Ventura & Danilo Fusco & Katia Bontempi & Paola Colais & Marina Davoli, 2018. "Regional Outcome Evaluation Program (P.Re.Val.E.): Reduction of inequality in access to effective health care in the Lazio region of Italy (2012–2015)," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-14, March.
  • Handle: RePEc:plo:pone00:0194972
    DOI: 10.1371/journal.pone.0194972
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194972
    Download Restriction: no

    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0194972&type=printable
    Download Restriction: no

    File URL: https://libkey.io/10.1371/journal.pone.0194972?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Laura Cacciani & Nera Agabiti & Anna Maria Bargagli & Marina Davoli, 2017. "Access to percutaneous transluminal coronary angioplasty and 30-day mortality in patients with incident STEMI: Differentials by educational level and gender over 11 years," PLOS ONE, Public Library of Science, vol. 12(4), pages 1-16, April.
    2. Ruger, Jennifer Prah, 2009. "Health and Social Justice," OUP Catalogue, Oxford University Press, number 9780199559978.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Daniel Adrian Lungu & Elisa Foresi & Paolo Belardi & Sabina Nuti & Andrea Giannini & Tommaso Simoncini, 2021. "The Impact of New Surgical Techniques on Geographical Unwarranted Variation: The Case of Benign Hysterectomy," IJERPH, MDPI, vol. 18(13), pages 1-14, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Matthijs M. Versteegh & Isaac Corro Ramos & Nasuh C. Buyukkaramikli & Amir Ansaripour & Vivian T. Reckers-Droog & Werner B. F. Brouwer, 2019. "Severity-Adjusted Probability of Being Cost Effective," PharmacoEconomics, Springer, vol. 37(9), pages 1155-1163, September.
    2. Penelope Weller, 2016. "Legal Capacity and Access to Justice: The Right to Participation in the CRPD," Laws, MDPI, vol. 5(1), pages 1-13, March.
    3. Regina Moczadlo & Harald Strotmann & Jürgen Volkert, 2015. "Corporate Contributions to Developing Health Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 16(4), pages 549-566, November.
    4. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    5. Jennifer Prah Ruger & Arbi Ben Abdallah & Craig Luekens & Linda Cottler, 2012. "Cost-Effectiveness of Peer-Delivered Interventions for Cocaine and Alcohol Abuse among Women: A Randomized Controlled Trial," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-12, March.
    6. Gough, Ian, 2014. "Climate change and sustainable welfare: an argument for the centrality of human needs," LSE Research Online Documents on Economics 58630, London School of Economics and Political Science, LSE Library.
    7. Marion Coste, 2021. "Beyond social determinants of health: an application of the Health Capability Model to rural Senegal," Working Papers halshs-03160413, HAL.
    8. Manuel Cebral-Loureda & Enrique Tamés-Muñoz & Alberto Hernández-Baqueiro, 2022. "The Fertility of a Concept: A Bibliometric Review of Human Flourishing," IJERPH, MDPI, vol. 19(5), pages 1-15, February.
    9. repec:cep:sticas:/182 is not listed on IDEAS
    10. Simon, Judit & Anand, Paul & Gray, Alastair & Rugkåsa, Jorun & Yeeles, Ksenija & Burns, Tom, 2013. "Operationalising the capability approach for outcome measurement in mental health research," Social Science & Medicine, Elsevier, vol. 98(C), pages 187-196.
    11. Wachira, Catherine & Ruger, Jennifer Prah, 2011. "National poverty reduction strategies and HIV/AIDS governance in Malawi: A preliminary study of shared health governance," Social Science & Medicine, Elsevier, vol. 72(12), pages 1956-1964, June.
    12. Pierre Pratley & John Floyd Sandberg, 2018. "Refining the Conceptualization and Measurement of Women’s Empowerment in Sub-Saharan Africa Using Data from the 2013 Nigerian Demographic and Health Survey," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 140(2), pages 777-793, November.
    13. Marion Coste, 2021. "Beyond social determinants of health: an application of the Health Capability Model to rural Senegal," AMSE Working Papers 2116, Aix-Marseille School of Economics, France.
    14. Shahjahan Bhuiyan, 2022. "COVID‐19 vaccine equity in doldrums: Good governance deficits," Public Administration & Development, Blackwell Publishing, vol. 42(5), pages 293-304, December.
    15. Ian Gough, 2014. "Climate Change and Sustainable Welfare: An Argument for the Centrality of Human Needs," CASE Papers case182, Centre for Analysis of Social Exclusion, LSE.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0194972. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.