Socioeconomic status and access to care in a universal health care system: The case of acute myocardial infarction in Australia
研究了澳大利亚全民医保下，社会经济地位如何影响急性心肌梗死患者的就医机会和生存率，发现弱势群体更难获得关键医疗服务，且资源紧张时差距扩大。
This paper examines the role of socioeconomic status (SES) in affecting access to care and the survival of acute myocardial infarction (AMI) patients in Australia's universal health care system. We jointly model the probabilities of patients being admitted to a catheterisation-capable hospital, receiving invasive coronary angiography (ICA), and surviving 30 days post discharge as a recursive system of probit equations. We further investigate the role of capacity and whether the access gap between SES groups widens when capacity becomes limited. Our study shows that SES plays a significant role in affecting the survival of AMI patients, both directly and indirectly through healthcare access. We find that socioeconomically disadvantaged patients are less likely to gain access to crucial services like catheterisation hospitals and ICA, which indirectly affects their survival probability in addition to the adverse direct impact of SES. While healthcare capacity showed no overall effect on access, its interplay with SES exacerbates the access disparity in situations of limited capacity. Our findings suggest that, to reduce inequality in health outcomes, public health strategy needs to focus not only on enhancing access but also addressing the direct consequences of SES.