Turkiye Klinikleri Journal of Medical Sciences

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Sosyal Sınıfın ve Sağlık Güvencesinin Manisa'daki Sağlık Hizmet Kullanımı Üzerine Etkisi: Bir Eşitsizlik Araştırması
Effect of Social Class and Social Security on Access to Healthcare in Manisa: A Research for Inequalities
Nasır NESANIRa, Gönül DİNÇb, Seval CAMBAZc, Pınar BAYSANd, Müjde ŞERİFHANe, Serol DEVECİc, Tümer PALAf, Cemil ÖZCANb
aİl Sağlık Müdürlüğü, Düzce bHalk Sağlığı AD, Celal Bayar Üniversitesi, Tıp Fakültesi, cCelal Bayar Üniversitesi, Sağlık Yüksek Okulu, Manisa dİl Sağlık Müdürlüğü, Tokat eİl Sağlık Müdürlüğü, Gümüşhane fSağlık İstasyonu, Hudut ve Sahiller Genel Müdürlüğü, Aliağa
Turkiye Klinikleri J Med Sci. 2010;30(4):1263-71
doi: 10.5336/medsci.2009-13542
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmada sosyal sınıf ve sağlık güvencesinin Manisa'daki ayakta ve yatarak tanı ve tedavi hizmeti kullanımı üzerine etkisi değerlendirilmiştir. Gereç ve Yöntemler: Manisa kent merkezi nüfusunu (n=232.760) temsil eden 11.284 hane halkı bireyine sağlık evi nüfuslarına orantılı küme örnek seçimi yöntemi ile ulaşılmıştır. Veriler, anket yapılan kişilere anketörler tarafından yüz yüze görüşme tekniği uygulanarak toplanmıştır. Farklı sosyal sınıfların ve sağlık güvencesi varlığının sağlık sorunu yaşama, ayakta ve yatarak tanı ve tedavi hizmetlerine ulaşma açısından kaba riskleri hesaplanmıştır. Çok değişkenli riskler yaş, cinsiyet ve kronik hastalık varlığına göre düzeltilmiştir. Bulgular: İşsizlerle karşılaştırıldığında son on beş günde üst sosyal sınıfta 1.79 (1.17-2.75), orta sosyal sınıfta 1.51 (1.10-2.06) ve alt sosyal sınıfta 1.44 (1.04-2.00) kat daha fazla sağlık sorunu yaşandığı tespit edilmiştir. Yine işsizlerle karşılaştırıldığında son on beş günde üst sosyal sınıfta 1.73 (1.08-1.46), orta sosyal sınıfta 1.46 (1.03-2.06), alt sosyal sınıfta 1.53 (1.07-2.20) kat daha fazla ayakta tanı ve tedavi hizmeti kullanımı olduğu anlaşılmıştır. Farklı sosyal sınıfların yaş, cinsiyet ve kronik hastalığa göre düzeltilmiş yatarak tanı ve tedavi görme riskleri benzerdir. Bununla birlikte sağlık güvencesi olanlarda, olmayanlara göre son on beş günde sağlık sorunu yaşadığını belirtme oranının 1.58 (1.17-2.13); son on beş günde ayakta tanı ve tedavi hizmeti alma oranının 2.57 (1.75-3.78) ve son bir yılda yatarak tanı ve tedavi görme oranının 3.37 (2.11-5.40) kat daha fazla olduğu ortaya çıkmıştır. Sonuç: Sağlık hizmetine ulaşmada işsizler ve sağlık güvencesi bulunmayanlar aleyhine eşitsizlikler olduğu görülmektedir.

Anahtar Kelimeler: Sosyal sınıf; sosyal güvenlik; sağlık hizmetleri
ABSTRACT
 Objective: In the following study, effect of social class and social security on reaching diagnostic and therapeutic health care services in Manisa is evaluated in both out-patient and in-patient basis. Material and Methods: The households were determined in proportion to targeting populations in health care facilities (health houses) by using cluster sampling method and 11284 people representing the population in Manisa city center (n:232760) was included in the study. The data was collected by pollsters using face to face technique. Crude risks were calculated in different social classes and in those with or without social security for history of health problems and access to diagnostic and therapeutic health care services on outpatient and the inpatient basis. Multivariable risks were revised in accordance with age, sex and chronic health problems. Results: In comparison to unemployed population, the health problems in last 15 days was 1.79 (1.17-2.75) times more common in upper social class and similar figures were also seen in middle social class and lower social class, being 1.51 (1.10 -2.06) and 1.44 (1.04-2.00), respectively. Moreover, reaching to diagnostic\\theraupetic health care services in last 15 days was 1.73 (1.08-1.46) times more common in upper social class and this value was 1.46 (1.03-2.06) in middle social class and 1.53 (1.07-2.20) in lower social class. The revised risks of having diagnostic and therapeutic health care were similar in different social classes. In comparison to those without any social security, it was found that those with social security reported having health problems 1.58 (1.17-2.13) times more, and this was also true for out-patient diagnostic\\therapeutic medical care being 2.57 (1.75-3.78) and inpatient being 3.37 (2.11-5.40) times more. Conclusion: There are inequalities against those being unemployed and those without social securities with respect to accessing to health care services.

Keywords: Social class; social security; health services

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