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Social deprivation in Danish primary care – presentation of an index

Social deprivation in Danish primary care – presentation of an index. Peter Vedsted Senior researcher, PhD. The Research Unit for General Practice Aarhus University Denmark p.vedsted@alm.au.dk. Consequences of deprivation. Lower socio-economic position (SEP) is associated with:

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Social deprivation in Danish primary care – presentation of an index

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  1. Social deprivation in Danishprimary care – presentation of an index Peter Vedsted Senior researcher, PhD. The Research Unit for General Practice Aarhus University Denmark p.vedsted@alm.au.dk

  2. 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)?

  3. 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?!

  4. 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

  5. Danish Deprivation Index (DADI) * lowest national quartile

  6. Example of variable from DADI2.189 practices in 2006 Proportion of 25-65-aged with low income Proportion of practice

  7. 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)

  8. Danish Deprivation Index (DADI)2189 practices 100 practices %

  9. 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

  10. 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

  11. 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)

  12. Danish Deprivation Index (DADI)

  13. 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

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