Morbidity Categories Research Articles

A widening health gap in general practice? Socio-economic differences in morbidity between 1975 and 2000 in The Netherlands

During the past two decades, socio-economic inequalities in health have been a major research theme in Western Europe. Research has shown that there are persistent differences in health between people with a high socio-economic status (SES) compared with people with a low SES. There are also indications for a widening health gap. The present paper aimed to find out whether this widening health gap exists in The Netherlands using morbidity data from a general practice (GP) registry. Incidence data from a GP registry were used, involving over 12,000 patients. Morbidity data from 1975 to 2000 were grouped into 25 disease categories. SES was based on household occupational status. Poisson regression was used to determine the relationship between morbidity and SES and its changes over time. Separate analyses were performed for men and women. In most disease categories, a clear SES gradient disadvantageous to the lowest-SES group was identified: 17 out of 22 morbidity categories for men and 17 out of 24 for women. For seven (men) and eight (women) morbidity categories out of 17, the SES gradient increased between 1975 and 2000. This study provides new evidence for a widening gap in health between higher and lower SES in The Netherlands, using GP-defined disease data and a wide range of morbidity categories.

Application of the ambulatory care groups in the primary care of a European national health care system: does it work?

Ambulatory Care Groups (ACGs), a US case-mix system that uses the patient as the unit of analysis, is particularly appropriate for health care systems in which physicians serve a defined list of patients. To determine the extent to which the categorization of patients according to ACGs would account for the utilization of primary care services in a national health care system within the European Union. Of all subjects continuously assigned to 9 physicians from public primary health care centers in Bizkaia, Basque Country (Spain) over a 12-month period, those visited at least once (n = 9,093) were included. According to the subject's age, sex, and ICD-9-CM diagnoses assigned during a year of patient-provider encounters, patients were classified by means of the ACGs system. Multiple linear regression analyses indicated that age and sex did not explain more than 7.1% of the variance in annual visits made by adults and 25.7% by children to primary care physicians. However, the r2 adjusted to the ACGs model was 50% and 48%, respectively, and even higher, that is 58% and 64% for another component of the system, the Ambulatory Diagnostic Groups (ADGs). Those results support the inadequacy of using the patient's age and sex alone to estimate physicians' workload in the primary health setting and the need to consider morbidity categories. The ACGs case-mix system is a useful tool for incorporating patients' morbidity in the explanation of the use of primary health care services in a European national health system.

Use of health services by Baltimore Medicaid recipients.

Medicaid legislation intended to remove financial barriers to health care for the poor. A household interview survey of the Metropolitan Baltimore area in 1968-69 shows that persons on Medicaid are the highest users of health services. More Medicaid recipients in Baltimore visited a physician in two weeks and one year; more were admitted one or more times to a hospital. The total number of days in a hospital per 100 persons was considerably greater for Medicaid adults. Higher utilization of health services in Baltimore can be explained by the fact that Medicaid recipients are sicker than the rest of the population. Fewer Medicaid recipients are healthy; more are acutely, chronically, or acutely and chronically ill; more are chronically ill with impairment. The higher rate of chronic illness accounts for higher hospital use for the working age population. When compared by morbidity categories, ill Medicaid recipients are using services at least at the same level as others, but healthy Medicaid recipients are using more services.