Social Determinants of Equity in Access to Healthcare for Tuberculosis Patients in Republic of Macedonia – Results from a Case-Control Study

Document Type: Original Article

Authors

1 Department of Social Medicine, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, Macedonia

2 National Institute of Public Health, Department of Social Medicine, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, Macedonia

Abstract

Background
Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM), Tuberculosis (TB) is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH) and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities.
 
Methods
Case-control study was conducted in the period March–December, 2013; “cases” are households of TB patients registered in the period July, 2012–June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO) World Health Survey questionnaire was used to
collect data.
 
Results
Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services.
 
Conclusion
The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts.

Keywords

Main Subjects


  1. de Looper M, Lafortune G. Measuring disparities in health status and in access and use of health care in OECD countries OECD Health Working Papers No. 43 [Internet]. 2009. Available from: http://www.oecd-ilibrary.org/docserver/download/5ksm88c0r7kj.pdf?expires=1411378248&id=id&accname=guest&checksum=2360B0C612F7E117249DC207531687E0
  2. Mackenbach JP, Stirbu I, Roskam AJ, Schaap M, Menvielle G, Leinsalu M, et al. Socio-economic inequalities in mortality and morbidity: a cross-European perspective. In: Tackling Health Inequalities in Europe: an Integrated Approach. Eurothine Final Report. Rotterdam: Department of Public Health, University Medical Centre Rotterdam; 2007.
  3. Mackenbach JP, Meerding WJ, Kunst AE. Economic Costs of Health Inequalities in the European Union. J  Epidemiol Community Health  2011; 65: 412-9. doi: 10.1136/jech.2010.112680
  4. Blas E, Sivasankara Kurup A. Equity, social determinants and public health programmes. Geneva: WHO; 2010
  5. Constitution of the World Health Organization [internet]. WHO, Basic Documents, Forty-fifth edition, Supplement, October 2006. Available from: http://www.who.int/governance/eb/who_constitution_en.pdf
  6. [No authors listed]. What is health? The ability to adapt. Lancet 2009; 373: 781. doi: 10.1016/s0140-6736(09)60456-6
  7. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011; 343: d4163. doi: 10.1136/bmj.d4163
  8. Jadad AR, O’Grady L. How should health be defined BMJ 2008; 337: a2900. doi: 10.1136/bmj.a2900
  9. Larson JS. The conceptualization of health. Med Care Res Rev 1999; 56; 123-36.
  10. World Health Organization (WHO). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health: Commission on Social Determinants of Health Final Report. Geneva: World Health Organization, Commission on Social Determinants of Health; 2008.
  11. Health Nexus and Ontario Chronic Disease Prevention Alliance. Primer to Action: Social Determinants of Health [internet]. 2008. Available from: http://en.healthnexus.ca/sites/en.healthnexus.ca/files/resources/primer_to_action.pdf
  12. Exworthy M. Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy Plan 2008; 23: 318-27. doi: 10.1093/heapol/czn022
  13. World Health Organization (WHO). Global strategy and targets for tuberculosis prevention, care and control after 2015 [internet]. 2013. Available from: http://www.who.int/tb/post_2015_tb_presentation.pdf
  14. WHO, Stop TB Partnership, The Global Fund to Fight AIDS, TB and Malaria. Reach the 3 million: Find. Treat. Cure TB. Geneva: WHO; 2014.
  15. World Health Organization (WHO). Health systems in transition. The former Yugoslav Republic of Macedonia:  WHO; 2002.
  16. Macedonia – Constitution [internet]. Available from: http://www.servat.unibe.ch/icl/mk00000_.html
  17. Lazarevik V, Donev D, Gudeva Nikovska D, Kasapinov B. Three periods of health system reforms in Republic of Macedonia (1991-2011). Prilozi 2012; 33: 175-89.
  18. World Health Organization (WHO). Global tuberculosis report. Geneva: WHO; 2013
  19. State Statistical Office, 2013. Available from: http://www.stat.gov.mk/OblastOpsto_en.aspx?id=2
  20. WHO Health statistics and information systems. World Health Survey Instrument and related documents [internet]. Available from: http://www.who.int/healthinfo/survey/instruments/en/
  21. Glewwe P. Household Sample Surveys in Developing and Transition Countries, 2010.
  22. McCrum-Gardner E. Which is the correct statistical test to use? Br J Oral Maxillofac Surg 2008; 46: 38-41. doi: 10.1016/j.bjoms.2007.09.002
  23. Lang T. Documenting research in scientific articles: guidelines for authors: 2. Reporting hypothesis tests. Chest 2007; 131: 628-32. doi: 10.1378/chest.06-2088
  24. 20 years of independent Macedonia [internet]. State Statistical Office, 2012. Available from: http://www.stat.gov.mk/Publikacii/20YearsOfINDEPENDENTMACEDONIA.pdf
  25. World Health Organization (WHO). Health systems in transition. The former Yugoslav Republic of Macedonia:  WHO; 2006.
  26. Preventive tuberculosis program in Republic of Macedonia. Ministry of Health, 2014.
  27. Ensuring high quality and sustainable DOTS interventions in Republic of Macedonia. Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, 2014.
  28. Insured individuals in Republic of Macedonia/Health Insurance fund, 2012.
  29. National TB Strategy 2008-2012. Ministry of Health, 2012.
  30. Tanimura T, Jaramillo E, Weil D, Raviglione M, Lonnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review. Eur Respir J 2014; 43: 1763-75. doi: 10.1183/09031936.00193413
  31. Fletcher JM, Frisvold DE. Higher Education and Health Investments: Does More Schooling Affect Preventive Health Care Use? J Hum Cap 2009; 3: 144-76. doi: 10.1086/645090