Abstract Body

Background and purpose

Segregation is a known risk factor for health. In Hungary, 332,658 inhabitants are living in the segregated colonies of 937 settlements. The number of people living in these settlements’ non-segregated parts (complementary areas) is 7,370,949. This study investigated the effect of segregation on healthcare use.

Methods

A cross-sectional study included all Hungarian settlements with segregated colonies. Data on health care services usage in 2019 (on the frequency of GP visits, outpatient services’ usage, and hospital admissions) was provided by the National Health Insurance Fund. Dissimilarity index (DI) was computed for each settlement as the ratio of age, sex, and eligibility for exemption certificate standardized service delivery frequency for colony and complementary areas. The effect of settlement-level social environment (education, employment, income, crowdedness of households, ethnicity, and county by the last census of 2011) on healthcare usage was evaluated by multivariate linear regression.

Results

Dissimilarity index aggregated for the whole country was DI=1.27 for GP visits, DI=0.95 for outpatient services, and DI=1.21 for hospital admission. Settlement-level DI was positively associated with proportion of Roma for frequency of GP visit (b=0.160, p=0.002), outpatient care (b=0.155, p=0.004), and hospital admission (b=0.183, p=0.001) Higher level of employment raised the DI for GP visits (b=0.198, p=0.008) and hospital visits (b=0.308, p<0.001). Moreover, rise in income increased the DI for GP visits (b=0.214, p=0.007) and outpatient services’ use (b=0.176, p=0.037).

Conclusion:

Living in segregated colonies is a strong influencing factor for healthcare service use, which is partly determined significantly by the local socio-economic environment.