Social disparities in access and quality of consultation in outpatient care in Germany.

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9918300889006676 Publication Model: Electronic Cited Medium: Internet ISSN: 2731-4553 (Electronic) Linking ISSN: 27314553 NLM ISO Abbreviation: BMC Prim Care Subsets: MEDLINE

Original Publication: [London] : BioMed Central Ltd., [2022]-

Health Services Accessibility*/statistics & numerical data ; Ambulatory Care*/statistics & numerical data ; Healthcare Disparities*/statistics & numerical data; Humans ; Germany ; Female ; Male ; Middle Aged ; Adult ; Cross-Sectional Studies ; Quality of Health Care/statistics & numerical data ; Quality of Health Care/standards ; Aged ; Primary Health Care/statistics & numerical data ; Primary Health Care/standards ; Referral and Consultation/statistics & numerical data ; Young Adult ; Adolescent ; Insurance, Health/statistics & numerical data ; Sex Factors ; Socioeconomic Factors ; Time Factors

Background: Overall, research on social determinants of access and quality of outpatient care in Germany is scarce. Therefore, social disparities (according to sex, age, income, migration background, and health insurance) in perceived access and quality of consultation in outpatient care (primary care physicians and specialists) in Germany were explored in this study.
Methods: Analyses made use of a cross-sectional online survey. An adult population sample was randomly drawn from a panel which was recruited offline (N = 2,201). Perceived access was assessed by waiting time for an appointment (in days) and travel time to the practice (in minutes), while quality of consultation was measured by consultation time (in minutes) and quality of communication (scale of four items, Cronbach's Alpha 0.89).
Results: In terms of primary care, perceived access and quality of consultation was worse among women compared to men. Estimated consultation time was shorter among people with statutory health insurance compared to privately insured respondents. Regarding specialist care, people aged 60 years and older reported shorter waiting times and better quality of communication. Lower income groups reported lower quality of communication, while perceived access and quality of consultation was worse among respondents with a statutory health insurance. Variances explained by the social characteristics ranged between 1% and 4% for perceived access and between 3% and 7% for quality of consultation.
Conclusion: We found social disparities in perceived access and quality of consultation in outpatient care in Germany. Such disparities in access may indicate structural discrimination, while disparities in quality of consultation may point to interpersonal discrimination in health care.
(© 2024. The Author(s).)

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Keywords: Access; Disparities; Germany; Primary care; Process quality; Social determinants; Specialist care

Date Created: 20240814 Date Completed: 20240814 Latest Revision: 20240817

20250114

PMC11323346

10.1186/s12875-024-02552-9

39143514