The chance of a better quality of health care depends on the place of residence – Regional disparities in access to health care in Hungary by the example of cataracta surgeries

Abstract

In order to examine the regional disparities in access to health care in Hungary we analysed all data on cataracta surgery financed by public sources in 2008. Cataracta surgery is one of the most frequent surgeries performed and is typically provided in an outpatient surgery setting. We used this type of treatment as an example to analyse inequalities in access to health care services in Hungary. The main goal was to develop a method to provide a decision-making basis for an informed health-care policy. We show that patients often cross administrative borders in order to find the surgery they preferred, and that there is a Budapest-centred typical pattern of such patient movements. Travel distance and time between the home address of the patient and the health care provider were analysed both for all surgeries and for out-patient surgeries separately. Rates of migration over the boundaries of regions, counties, and micro-regions as well as utilisation rates of the closest providers were evaluated. For a deeper understanding, two micro-regions were examined in detail. Lorenz curves and Gini coefficients were used to measure inequalities.
In all, 62,938 cataracta surgeries were performed in Hungary in the year 2008. 36% of the surgeries were provided for patients from Hungary’s Central Region. Half of the total number of surgeries was performed by 18 providers - out of 73 where this treatment would have been also available. At the level of the micro-regions examined, the Gini coefficient was 0.15, showing only a moderate level of inequality. 50 out of 73 providers were able to offer an outpatient surgery option. The total ratio of outpatient surgery was 22%. Inequality in access to outpatient surgery was, however, much higher: At county level, the Gini coefficient was 0.38.
Our study shows that the availability of a higher-quality health care depends on the place of residence. There was a huge inequality of the length of travel to the preferred surgery  provider. This may be partly explained by the referral system. The study offers proposals for improving the regional health care organisation.
Opportunities for economising on resources include eliminating unnecessary travel and increasing the rate of outpatient surgery: At present, the Hungarian ratio of 22% is well below the 50% of the OECD average. Increasing the role of outpatient surgery (ambulatory care) would lead to a marked decrease in the hospital beds required. In order to prevent unwanted negative effects, capacity adjustment in hospital beds should, however, not be accompanied by a lower budget for cataracta surgery.  Optimising patient travel, improving efficiency of health care and improving health-care infrastructure require further scientific research in the field of health system analysis and modelling, based on patient migration data.