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Intersectionality, equity and health care: Estimating complex inequalities in health care utilization by gender and socioeconomic position in Northern Sweden.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
2019 (English)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [en]

Background: Various methods have been developed to estimate horizontal equity in health care utilization on the one hand, and to analyse health status among intersectional groups on the other. However, there is limited availability of methods that estimate horizontal equity in health care utilization between groups defined by multiple intersectional categories. The study aims to estimate intersectional inequalities and horizontal inequities in health care utilization by gender and socioeconomic position in Northern Sweden, applying a novel methodological approach tailored specifically for this purpose.

Methods: Participants (N=23587) to the Health on Equal Terms survey of 2014 from 4 Northern Sweden counties or regions had data gathered through a postal self-administered questionnaire and population registers. Responses on health care utilization and perceived health care needs (age, chronic conditions, physical limitations and allergies) was self-assessed. Four intersectional categories representing high educated men, low educated men, high educated women and low educated women were created. Health care utilization differences between high educated men and low educated women (joint disparity), high educated men and low educated men (referent SEP disparity), high educated men and high educated women (referent gender disparity) were estimated. The excess intersectional disparity i.e. the difference between the joint disparity and the combined sum of the referent disparities was also estimated.

Results: The results showed the presence of referent socioeconomic position, referent gender and joint inequalities in the utilization of general practitioner visits. Joint and referent inequities were also observed for general practitioner consultations. Joint, referent socioeconomic position inequalities and no inequities were observed for specialist visits. No excess intersectional disparities were observed for either GP or specialist visits.

Conclusion: There was inequities in utilization of general practitioners whilst there was equitable utilization of specialist doctors between intersections of gender and socioeconomic position in Northern Sweden. Health seeking behaviours and health system related factors can shape the complex health utilization outcomes between groups with complex disparities of gender and socioeconomic position.

Place, publisher, year, edition, pages
2019. , p. 39
Series
Centre for Public Health Report Series, ISSN 1651-341X ; 2019:1
Keywords [en]
Intersectionality, Horizontal equity, Referent disparities, Joint disparities, Vertical equity.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-165588OAI: oai:DiVA.org:umu-165588DiVA, id: diva2:1373454
External cooperation
Health on Equal terms, Västerbotten, Jämtland/Härjedalen, Norrbotten and Västernorrland County Councils
Educational program
Master's Programme in Public Health
Presentation
2019-05-22, Room A309, Caring Science Building, Umeå University, Umeå, 09:00 (English)
Supervisors
Examiners
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2019-11-27Bibliographically approved

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Nyamande, Fortune Nyasha
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CiteExportLink to record
Permanent link

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Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf