Peter Vedsted

Social deprivation in Danishprimary care – presentation of an index

Peter VedstedSenior researcher, PhD.

The Research Unit for General Practice

Aarhus University

Denmark

p.vedsted@alm.au.dk

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)?

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?!

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

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

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

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)

Peter Vedsted

Danish Deprivation Index (DADI)2189 practices

%

100 practices

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

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

Peter Vedsted

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

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

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