Life satisfaction and its dependence on the diversity of socio

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HEALTH AND WELLNESS 3/2014
WELLNESS AND FAMILY
CHAPTER VII
1
Clinic of Paediatric Neurology
III Faculty of Paediatrics
Medical University of Lublin
Klinika Neurologii Dziecięcej
III Katedra Pediatrii
Uniwersytet Medyczny w Lublinie
2
Faculty of Earth Sciences and Spatial Planning
Maria Curie-Skłodowska University, Lublin
Wydział Nauk o Ziemi i Gospodarki Przestrzennej
Uniwersytet M. Curie-Skłodowskiej w Lublinie
EWA ZIENKIEWICZ1, TADEUSZ ZIENKIEWICZ2, MARIA KLATKA1,
SŁAWOMIR DZIADUCH2, KRYSTYNA MITOSEK-SZEWCZYK1
Life satisfaction and its dependence
on the diversity of socio-economic development
and accessibility to public healthcare
Wpływ regionalnego zróżnicowania rozwoju społeczno-ekonomicznego
i dostępności do publicznej służby zdrowia na zadowolenie ludności
ze zdrowotnego aspektu ich życia
Keywords: socio-economic development, access to public healthcare service, satisfaction from the health aspect of life
Słowa kluczowe: rozwój społeczno-gospodarczy, dostęp do publicznej służby
zdrowia, zadowolenie ze stanu zdrowia
The aim of the socio - economic development is the satisfaction derived by people from making changes. One of the main roles in the perception of satisfaction,
including the health aspect of life, plays access to healthcare services, cover in particular those provided by the State, and therefore, to the public healthcare services.
Healthcare is one of the basic tasks of modern states, and issues relating to them are
of interest to various disciplines, including: public health, economics, politics and
law. Events of the transformation started in the second half of the twentieth century
Wellness and family
shaped the realm of economic and social policy, including health caused a delay in
relation to the "old" EU members. The good side of this delay is that Poland could
benefit from the achievements and experiences of these countries and mitigate the
existing differences. Access to health care in Poland is regulated by the adequate law
Act [1]. The study demonstrates the existence of regional differences in access to
public health services in Poland in 2010.
METHODS
To show the regional disparities and inequality in access to public healthcare
system in Poland in 2010 year, as an entity of regional autonomy, the voivodeships
were used, because of the fact that the voivodeship branches of the National Health
Fund shall oversee and coordinate the implementation the health policy. Poland is
divided into 16 voivodeships.
Due to the fact that GDP per capita does not carry information about the distribution of income in society, does not indicate the level of illiteracy, infant mortality
and life expectancy of people, cannot be treated as the sole determinant of the level
of economic development. For this purpose, the Human Development Index (HDI)
for each voivodeship of Poland was analyzed. Methodology to calculate the HDI is
well known and is presented by UNDP [2]. Human Development Index is a synthetic measure that describes the effects of socio-economic development of individual
voivodeship. This system firstly was introduced by the United Nations for the purpose of international comparisons. Because of its universality it could be implemented to the regional research too. HDI measures the average achievements of a
region in three basic dimensions of human development:
1) healthy and long life, assessed using the ratio of the average length of life;
2) education (knowledge), the measured indicators: a literacy - the ability to
read and write with understanding, former school;
3) standard of living, defined by GDP per capita in PPP terms. Individual meters
have fixed ranges of values, which currently are: the average life expectancy:
25-85 years; the overall enrollment rate: 0-100%; reading comprehension and
writing: 0-100% indicator; gross domestic product per capita at purchasing
power parity in USD currency (U.S. $ PPP) per capita
Voivodeships, using quartile method, were divided into four groups according to
the HDI. The calculated value of Human Development Index is presented in Table I.
Voivodeships, using quartile method also, were divided into four groups according to the satisfaction index (HSI).
To determine the degree of accessibility to public health services in Poland taxonomic measure of accessibility (TMA) was used. The mentioned measure was used
as the indicator of the access to health care and was calculated using the Hellwig
method [3]. Firstly statistical features had been selected (Table I).
82
Ewa Zienkiewicz, Tadeusz Zienkiewicz, Maria Klatka, Sławomir Dziaduch,
Krystyna Mitosek-Szewczyk
Life satisfaction and its dependence on the diversity of socio-economic development and accessibility to public healthcare
Table I Statistical features
X1
No of physicians in public health care service sector per 10 000 inhabitants
X2 Specialists involved in the total no of physicians in public health care service sector [%]
X3
X4
Number of nurses per 10 000 inhabitants in public sector
No of hospital beds per 10 000 inhabitants in public sector
X5
X6
No of GPs teams (GP contracts with NHF) per 10 000 inhabitants
No of physicians in GPs team per 10 000 inhabitants
X7
Health expenditure in voivodeship per capita [PLN]
After determining the pattern of access to medical services
where “j”
is a stimulant, the taxonomic distances, between the individual and the object model,
was established. To determine the object model, the average values for each feature
were used. The maximum TMA index for the model object is equal "1". Synthetic
measure for each unit is described by the formula:
where, di - a measure of accessibility; ci0 - taxonomic distance of each unit zij to
model object z0j; c0 - a critical distance from the model of the unit. Used multiplicities are expressed as:
where
and
+2
,
and
and
Values of taxonomic measure of accessibility (TMA) are presented in Table II.
Disparities in access to public health care, according to TMA can be observed.
To examine the relationship between HIS and the availability of health care represented by TMA, and HDI, analysis of variance was used. Voivodeships were divided into four groups based on the quartile of HDI and TMA. Two hypotheses were
posed: (1) Hypothesis 0: mean values are equal in quartile groups; (2) Alternative
hypothesis: mean values are differing.
Table II HDI, TMA and HSI indexes
Voivodeship
HDI
TMA
HSI
Dolnośląskie
0,8947 0,7417 0,5900
Kujawsko-pomorskie 0,8806 0,7483 0,5900
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Wellness and family
Voivodeship
HDI
TMA
HSI
Lubelskie
0,8869 0,7602 0,5600
Lubuskie
0,8672 0,6650 0,5900
Łódzkie
0,8769 0,7652 0,5600
Małopolskie
Mazowieckie
0,8910 0,6960 0,6100
0,9258 0,7393 0,5600
Opolskie
Podkarpackie
0,8797 0,7122 0,6100
0,8792 0,7650 0,5900
Podlaskie
Pomorskie
0,8791 0,7458 0,5700
0,8963 0,6609 0,5900
Śląskie
Świętokrzyskie
0,8931 0,7822 0,6100
0,8805 0,8089 0,6200
Warmińsko-mazurskie 0,8733 0,6881 0,5500
Wielkopolskie
0,8998 0,6614 0,5600
Zachodniopomorskie 0,8808 0,7298 0,5700
Source: HDI, TMA – Own calculation; HSI - [4]
DATA SOURCES
Data for calculating HDI as: population, schooling indexes, life expectancy and
Gross domestic product per capita (GDP) derived from purchasing power parity
calculations, were obtained from the Database of the Central Statistical Office. Satisfaction index (HSI) was calculated based on data from the Central Statistical Office [4]. Data for calculating taxonomic measure of accessibility (TMA) includes
such data as: number of physicians and nurses, no of hospital and hospital beds, GPs
teams and number of GPs contracts with National Health Found and health expenditure in each voivodeship. The above data were collected from databases of: Ministry
of Healthcare, National Health Found (NHF), Found and ZOZ Registry - Registry
CSIOZ Health Care Facilities, Central Statistical Office. The number of physicians,
nurses, no of hospital and hospital beds were taken from the database of the Ministry
of Healthcare [5]. Data on the GPs teams and contracts with NHF and health care
services provided under these contracts were obtained from the database of the
Found and ZOZ Registry - Registry CSIOZ Health Care Facilities [6; 7]. Population,
schooling indexes, life expectancy and GDP data were obtained from the Database
of the Central Statistical Office [8; 9; 10].
STATISTICAL ANALYSIS
A measure of health satisfaction index (HSI) has been tested for correlation with
socio - economic development (HDI) and the taxonomic measure of access to medical services (TMA) The level of statistical significance was set at P <0.05. Data
were analysed with STATISTICA (data analysis software system), version 9.1.
84
StatSoft, Inc. (2010). Figures are prepared using the program Quantum GIS version
1.6.0 “Copiapó”.
RESULTS
The analysis of variance (HSI / HDI) shows that there is no reason to reject the
null hypothesis, therefore, the average quartile groups did not differ in a statistically
significant way. Value of the F-statistic and p-value significantly higher than the
assumed level of alpha = 0.05.
The analysis of variance (HSI / TMA) indicates that there is no reason to reject
the null hypothesis, therefore, the average quartile groups did not differ in a statistically significant way points to the value of the F-statistic and p-value significantly
higher than the assumed level of alpha = 0.05
Table III Table of correlation
Index TMA
TMA
HDI
HSI
HDI
HSI
1,0000 -0,0309 0,2347
p= ---
p=0,910 p=0,382
-0,0309 1,0000 -0,1312
p=0,910
p= --- p=0,628
0,2347 -0,1312 1,0000
p= 0,382 p= 0,628 p= ---
Source: Own calculation
Table of correlation (Table III) indicates that between satisfactions index (HSI)
and measure of accessibility to the public healthcare (TMA) and also the socio –
economic development index (HDI) of voivodeships, relationship is not observed.
During the study, the correlation between the HSI and TMA and HDI, gave a negative result. One of the reasons for the lack of differentiation due to the HDI and
TMA can be low volatility HSI. The coefficient of HSI variation was 3.79%, while a
sufficient level of variation, considered by the literature should to be at least 10%.
DISCUSSION
Analysis of the table (Table III) indicates that there is a weak negative correlation between the level of socio-economic development and the level of satisfaction
with the health aspect of the inhabitants of the regions concerned. The results of the
study indicate that the inhabitants of areas with a high level of socio-economic development (mazowieckie, wielkopolskie) show greater dissatisfaction with their
health. In the case of the mazowieckie and wielkopolskie index HSI is equal 0.56 at
HDI equal respectively 0,9258 and 0,8998. But regarding to the availability index
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Wellness and family
(TMA) in these provinces, we notice that this two voivodeships lie on the opposite
sites of the access to public healthcare services.
One of the factors which may combine the inhabitants of polarized, according to
TMA, provinces is aware of the role of health in the lives of individuals and society,
and greater attention to their own health and family.
Figure 1 Accessibility to public healthcare in Poland in 2010
86
Figure 2 Areas inhabited by persons satisfied with their health
The low level of accessibility to public healthcare services in Poland can be observed in the pomorskie, lubuskie or małopolskie too. In these regions the percentage of people satisfied with their health (pomorskie, lubuskie) is equal 59%. Only in
małopolskie, percentage of satisfied people is higher and amounts to 61%. In this
group of provinces, there are areas with a high HDI index (pomorskie-0,9860; małopolskie – 0,8910).
The correlation between the socio – economic development and regional diversity in access to public healthcare in Poland on the population satisfaction from health
aspect of their life gave negative result, and it allow us to say that linear dependency
between the examined factors doesn’t exists. At the present stage of research
(NUTS-2 level), it is not possible to precisely quantify the relationship between test
parameters. In each province there are regions (counties, municipalities) poorer and
richer and with different levels of access to health care. It is possible that the delimitation of Polish area with respect to the parameters set out in this paper would give
the real answer and solve the presented research problem.
It is necessary to underline, that no correlation between the TMA and the level of
HDI has been found. Only in mazowieckie voivodeship we can unequivocally state
that the high level of access to public health services correlates with high level of
socio - economic development. mazowieckie with main city Warsaw, rather than in
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Wellness and family
other parts of Poland may offer more possibilities for physicians. It is significant that
the shortage of specialists, which has a significant impact on access to basic health
care, sustainable occurs in regions with a high HDI (pomorskie, zachodniopomorskie, malopolskie) and a low level of the index (lubuskie). One of the explanations
can be the migration of physicians [11; 12]. Physicians choose the place of their
employment depending on the offer and demand on the labour market and on the
advantages that each environment offers. As early as during their internship, physicians mostly choose to work in the main cities of regions where you can find medical schools and universities rather than in other part of Poland, or try to create their
own future abroad [13; 14].
The following factors play a considerable role in forming this situation: international migration of physicians; Circular migration - in border areas, locum work,
shift work; mostly to Germany, Great Britain, Scandinavian countries (pomorskie,
pubuskie, zachodniopomorskie,); Internal migration - from the regions where medical universities are located, and where specialist live and are employed (as first
working place) to regions where there are no such units and the demand for specialists are higher than in their home regions and form public to private sector. The
above mentioned factors could be treated as reason of the negative impact for population satisfaction from their health.
Interregional and international migration is not unique only to the Polish territory. It is also evident in many other countries [15; 16; 17; 18; 19; 20]. Unlike in other
countries, the salaries of Polish physicians cannot be the only one explanation for
uneven distribution of physicians between richer and poorer voivodeships. The value of taxonomic measure of accessibility to public health care in one of the reaches
region in Poland - Wielkopolskie voivodeship, is lower than in the poorest one as
warmińsko-mazurskie or łódzkie.
Another cause of physicians’ emigration is deteriorating situation of public hospitals. Founding bodies for health care facilities operating in the public sector are
mainly government bodies and local universities or medical (clinical unit). Although
the Act does not specify the rules for the distribution and use of public funds by both
providers, in fact, the public sector is favored when contracts. One of the most serious problems of the system since the reform of 1999 is a multidisciplinary hospital
debt. Their debt consists of 90% of debts of all public health care facilities. The
primary cause was the so-called “over limit realization services” - services rendered
over the contracted limit of NHF, for which the NHF did not pay [21]. Other factors
contributing to the result of the already mentioned failure is the ownership status and
lack of supervision of the actual their activity. Hospitals do not always manage effectively, as well as unsuccessful taken investment. Hospitals’ debt and each year
reduction of annual contracts by the NHF for public health is the main reason for
seeking alternative earnings sources by professionals. For this reason, in the wealthier areas of Poland occurs the transfer of specialists from the public sector to the
private sector which offers much better conditions. Paradoxically, this situation is
inspired by the current health care system in Poland. On the one hand, we have
poorly paid medical specialists in public health care and limited health care contracts
88
by the NHF and on the other hand, the private sector, which fills the gap of the medical services created as a result of the NHF activity, but still too expensive for regular citizen. Moreover, one of the most important problems of the Polish system is the
low level of funding. In the period 1990-2007 the share of public expenditure in
general expenses decreased from 92% to 70.8% [22].
The right to health is one of the basic human rights and is, as such, guaranteed by
the Constitution of the Republic of Poland. Therefore, greater commitment from of
all the stakeholders is required to uphold that right and it shouldn’t be closely connected with financial sources only. To increase the number of physicians, it is necessary to offer some incitements for medical students and young physicians, such as
the existing salaried internship and residency programs or solution to the housing
problem. However, due to significant differences between counties, the incentives
should be tailored to the needs of a specific environment rather than applied uniformly to all regions.
CONCLUSION
Greater satisfaction with the health status of the inhabitants of the southern provinces is registered. A weak negative correlation with the level of socio-economic
development and a positive correlation with the index of access to public healthcare
service, do not allow for an unambiguous estimate of the influence of taken factors,
on the level of satisfaction of residents from the health aspect of their life, because
they are not statistically significant. The obtained results indicate that this test
should be performed on smaller territorial units (NUTS-3). However, to get the data
for the calculation of both HDI and TMA for these areas can pose significant difficulties or be downright impossible. This can occur because the statistical office does
not publish the relevant data for such areas.
ACKNOWLEDGMENT
The opinions set forth are opinions of authors, not the official attitudes of their
institutions.
REFERENCES
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3. Grabiński, T., Wydymus, S., Zeliaś, A. Metody taksonomii numerycznej w
modelowaniu zjawisk społeczno - gospodarczych. Warszawa : PWN, 1989.
4. Główny Urząd Statystyczny. Jakość życia, kapitał społeczny, ubóstwo i
wykluczenie społeczne w Polsce. Warszawa : GUS, 2013.
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5. Ministerstwo Zdrowia. Centrum Systemów Informacyjnych Ochrony Zdrowia.
Biuletyn Statystyczny. Warszawa : Ministerstwo Zdrowia, 2011.
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[Online] [Cited: 11 10 2012.]
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Urząd Statystyczny, 2012.
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Olsztyn : Gówny Urząd Statystyczny, 2011.
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Lokalnych. Układ wg rejestru TERYT. [Online] [Cited: 11 10 2012.]
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12. Norcini, J.J. and Mazmanian, P.E. Physician migration, education, and health
care. Journal of Continuing Education in the Health Professions. 2005, Vol. 1,
25, pp. 4-7.
13. Marchal, B. and Kegels, G. Health workforce imbalances in times of
globalization: brain drain or professional mobility? Int J Health Plann Manage.
2003 Oct-Dec, 18 Suppl 1, pp. 89-101.
14. Gontarek, R. Weekendowa emigracja zarobkowa zamiast wyjazdu na stałe.
Rynek Zdrowia.pl. [Online] 05 03 2012. [Cited: 27 12 2012.]
http://www.rynekzdrowia.pl/Finanse-i-zarzadzanie/Weekendowa-emigracjazarobkowa-zamiast-wyjazdu-na-stale,117536,1.html.
15. Kobayashi, Y. and Takaki, H. Geographic distribution of physicians in Japan.
Lancet. 1992, 340, pp. 1391–3.
16. Wilkinson, D., Symon, B. Inequitable distribution of general practitioners in
Australia: estimating need through the Robin Hood Index. Aust N Z J Public
Health. 2000, 24, pp. 71-75.
17. Theodorakis PN, Mantzavinis GD. Inequalities in the distribution of rural
primary care physicians in two remote neighboring prefectures of Greece and
Albania. Rural Remote Health. 2005, 5, p. 457.
18. Plotnikova, E. Cross-border mobility of health professionals: Contesting
patients’ right to health. Social Science & Medicine. 1, 74, pp. 20-7.
19. Tjadens, F., Weilandt, C. and Eckert, J. Mobility of Health Professionals. Berlin,
Heidelberg : Springer-Verlag, 2013.
20. Kolcic, I., et al. Research involvement, specialty choice, and emigration
preferences of final year medical students in Croatia. Croat Med J. 2005, 46, pp.
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22. OECD Health Data 2009. Health Policy: Public share of health expenditure
OECD countries, 2007 and change since 1990. s.l. : OECD, 2009.
ABSTRACT
The main aim of this paper is to examine the impact of the socio – economic development and regional diversity in access to public healthcare in Poland on the
population satisfaction from health aspect of their life. Voivodeships were divided
into four groups, using quartile method, according to the access to public healthcare
in Poland and socio - economic development level. Socio-economic development
level was identified by the Human Development Index (HDI) for each voivodeship.
Disparities level to access to the public healthcare was identified by taxonomic
measure of accessibility (TMA). Health satisfaction index (HSI) was compared in
the different regions, depending on the level of HDI and TMA index. The study of
correlation between HSI and HDI, and TMA gave a negative result. At the same
time it was explained, that the relationship of health satisfaction and accessibility to
public health and socio-economic development, in each tested region is non-linear.
A larger proportion of people satisfied with the state of his health reside in the
southern provinces. Irrelevance of HSI correlation with the level of socio-economic
development and the indicator of access to public healthcare services may be due to
disparities inside each region. It is advisable to carry out research in areas smaller
than the voivodeship - (NUTS -3).
STRESZCZENIE
Celem niniejszej pracy jest zbadanie wpływu rozwoju społeczno-gospodarczego
województw oraz regionalnego zróżnicowania w dostępie do publicznej służby
zdrowia na zadowolenia mieszkańców z punktu widzenia zdrowotnych aspektów ich
życia. Województwa zostały podzielone na cztery grupy, z zastosowaniem metody
kwartyli, wg dostępu do publicznej służby zdrowia w Polsce oraz pod względem
poziomu rozwoju społeczno-gospodarczego. Poziom rozwoju społecznogospodarczego został zidentyfikowany przez wskaźnik Human Development Index
(HDI) dla każdego województwa. Różnice poziomu w dostępie do publicznej opieki
zdrowotnej zostały zidentyfikowane poprzez zastosowanie taksonomicznej miary
dostępności (TMA). Indeks satysfakcji Zdrowia (HSI), określający procent osób
powyżej 16 roku życia, zadowolonych ze swojego zdrowia, porównano w różnych
regionach w zależności od poziomu HDI i wskaźnika TMA. Badanie, korelacji pomiędzy HSI i HDI oraz TMA, dało wynik negatywny. Jednocześnie wyjaśniono, że
zależność zadowolenia z aspektu zdrowotnego a dostępnością do publicznej służby
zdrowia oraz rozwojem społeczno-gospodarczym każdego badanego regionu nie ma
charakteru liniowego. Większy odsetek osób zadowolonych ze stanu swego zdrowia
zamieszkuje w województwach południowych. Nieistotność korelacji HSI z poziomem rozwoju społeczno-gospodarczego oraz ze wskaźnikiem dostępu do publicznej
służby zdrowia, może być spowodowana zróżnicowaniem wewnątrz województw.
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Wellness and family
Wskazane jest przeprowadzenie badań na obszarach mniejszych niż województwa (NUTS-3).
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Life satisfaction and its dependence on the diversity of socio

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