social deprivation in danish primary care – presentation of an index
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Social deprivation in Danish primary care – presentation of an index. Peter Vedsted Senior researcher, PhD. The Research Unit for General Practice Aarhus University Denmark [email protected]. Consequences of deprivation. Lower socio-economic position (SEP) is associated with: - PowerPoint PPT PresentationTRANSCRIPT
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Peter Vedsted
Social deprivation in Danishprimary care – presentation of an index
Peter VedstedSenior researcher, PhD.
The Research Unit for General Practice
Aarhus University
Denmark
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Peter Vedsted
Consequences of deprivation Lower socio-economic position (SEP) is associated with:
Higher exposure to risk factors
Higher incidence of diseases
Delayed diagnose
Lower quality of treatment and follow-up
Higher mortality
Thus: Providing health care for patients with low SEP require that GPs work
harder and smarter!
Is the health care system supporting this (e.g. fair payment of GPs)?
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Peter Vedsted
Danish general practice
Free access to GP who is frontline and gatekeeper
‘General practice in Denmark guarantees free and equal access to medical advice’
However, we see: Lack of GPs in deprived areas
GPs in deprived areas do not have enough time, skills and help
Have we busted the Danish model with equal access?!
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Peter Vedsted
Danish Deprivation Index (DADI) AIM:
to provide an index of deprivation in Danish general practice
Method: All inhabitants have unique personal identification numbers (CPR)
National database with socio-economic variables (Statistics Denmark)
8 key variables included in the index
Each practice characterised according to the variables with a sum-score
DADI made in collaboration with:Torben Højmark Sørensen and Kim Rose Olsen, DSI, Denmark
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Peter Vedsted
Danish Deprivation Index (DADI)
Variables
1 Proportion of 20-59-aged unemployed for at least 6 months
2 Proportion of 25-59-aged with no professional education
3 Proportion of 25-65-aged with low* income (adjusted to family size)
4 Proportion of 18-59-aged with a transfer income/benefits
5 Proportion of children (0-16) from families with no professional education
6 Proportion of immigrant/descendents from non-western countries
7 Proportion of 30+ year living alone
8 Proportion of 70+ year with low* income
* lowest national quartile
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Peter Vedsted
Example of variable from DADI2.189 practices in 2006
.1.2
.3.4
.5.6
Va
riabe
l 3
0 .25 .5 .75 1Andel praksis
Proportion of 25-65-aged with low income
Proportion of practice
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Peter Vedsted
Sum score of DADI
Each variable divided into 10 pieces -> 1-10 points
Each variable weighted according to importance
A DADI sum score for a practice population is made (10-90)
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Peter Vedsted
Danish Deprivation Index (DADI)2189 practices
%
100 practices
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Peter Vedsted
Consequences for list size and earning
For every 10 points on DADI: Number of listed patients per GP decreases by 50
Earning decreases by 35,000 DKR per GP per year
Example; 2 solo practices with DADI score 30 and 70, respectively +200 patients
+140,000 DKR in remuneration
Preliminary data from DADI study: Kim Rose Olsen, Torben Højmark Sørensen, DSI, Denmark
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Peter Vedsted
Conclusion
We are able to measure deprivation in each Danish practice
Number of listed patients per GP and earnings decreases significantly when deprivation increases
A group of practices have high deprivation scores
This challenges: The willingness of GPs to work in deprived areas
A fair remuneration of GPs
Equality in health care from general practice
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Peter Vedsted
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Peter Vedsted
Sum-score from the 8 variablesVariable divided into deciles
Example: Variable with values from 0.040 to 0.630
Difference divided into 10 exact equal parts (0.059 each)
Example (Proportion of 20-59-aged unemployed for at least 6 months)
Interval 0.040 - 0.099 - 0.158 - 0.217 - 0.276 - 0.335 - 0.394 - 0.453 - 0.512 - 0.571 - 0.630Point 1 2 3 4 5 6 7 8 9 10
Point 1 2 3 4 5 6 7 8 9 10Practices 111 557 753 434 188 78 37 16 12 3
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Peter Vedsted
Danish Deprivation Index (DADI)Variable Weight
1 Proportion of 20-59-aged unemployed for at least 6 months 0.100
2 Proportion of 25-59-aged with no professional education 0.125
3 Proportion of 25-65-aged with low income (adjusted to family size) 0.100
4 Proportion of 18-59-aged with a transfer income/benefits 0.100
5 Proportion of children (0-16) from families with no professional education 0.150
6 Proportion of immigrant/descendents from non-western countries 0.250
7 Proportion of 30+ year living alone 0.075
8 Proportion of 70+ year with low income (lowest national quartile) 0.100
Total 1.000
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Peter Vedsted
Danish general practice
Tax financed health care system
2,200 general practices with 3,500 GPs
GPs are responsible for own practice
Contract with health insurance, 75% fee-for-service, 25% capitation
List system with 98% of population registered
1,550 listed persons per GP