Şcoala Naţională de Sănătate Publică şi Management Sanitar
Abstract
Summary: Purpose: to study the geographical disparities in the consumption of hospital services and their potential causes Methodology:The study presented in the article is a descriptive observation one, conducted for the year 2008. The analysis included all the cases discharged from continuous acute care hospitals in Romania, considered valid.There were studied the following hypotheses:the excess in consumption of hospital services (measured by the standardized ratio of the cases and of the hospitalization days, according to the age group) is associated with a lower standard of living and a greater number of bedsthe excess consumption of hospital services generates a reduction of the mortality in the general population in that geographic areas (measured by the standardized mortality report by age group).The association between these variables was tested for the 8 development regions (the Spearman correlation test) respectively for the patient's home county (the Pearson correlation test), using the statistical analysis software SPSS. Results:Although differences in the consumption of among the different development regions, respectively among the counties, are obvious, no association between the high volume of hospital services and mortality was found; therefore, it can be assumed that excessive consumption of services is not accompanied by an improving of the health status of patients as mortality reduction. The income influences poorly the volume and the outcome of the healthcare, but correlates with the number of hospital beds in counties with a higher income level. There is no correlation between the number of hospital beds and the volume of the consumed services. Although, at county level, the correlation between the number of cases and the hospitalization days are proven, there are development regions that surprises by the overall scarcity of cases, but excess hospital days. Conclusions There are variations in hospital care practice, which should be measured and analyzed in terms of causes, and should be prevented through monitoring the service needs, data reporting and the careful assessment of the structures and the resources.Scop: studierea disparitatilor geografice in consumul de servicii spitalicesti si a potentialelor cauze ale acestora. Metodologie: Studiul prezentat in articol este unul observational descriptiv, desfasurat pentru anul 2008. Au fost incluse in analiza toate cazurile externate din spitalele de acuti din Romania, considerate valide. Ipoteze de studiu:1. excesul de servicii spitalicesti consumate (masurate prin raportul standardizat al cazurilor si al zilelor de spitalizare in functie de grupa de varsta) se asociaza cu un nivel de trai mai scazut si cu un numar de paturi mai mare.2. excesul de servicii spitalicesti determina in zonele geografice respective o scadere a mortalitatii in populatia generala (masurata prin raportul standardizat al mortalitatii dupa grupa de varsta).Testarea asocierii a fost facuta la nivelul celor 8 regiuni de dezvoltare (test corelatie Spearman), respectiv judet de domiciliu al pacientului (test corelatie Pearson), cu programul de analiza statistica SPSS. Rezultate: Desi diferentele in consumul de servicii spitalicesti la nivelul regiunilor de dezvoltare, respectiv judetelor, sunt evidente, nu a fost gasita nici o asociere intre volumul mare de servicii spitalicesti si mortalitate; ca urmare, consumul excesiv nu este insotit de imbunatatirea starii de sanatate a pacientilor in sensul scaderii mortalitatii. Venitul influenteaza in mica masura volumul si rezultatul ingrijirii, dar se coreleaza cu numarul paturilor de spital din judetele cu un nivel mai mare al veniturilor. Nu exista o corelatie intre numarul paturilor de spital si volumul serviciilor consumate. Desi la nivel de judet exista corelatie dovedita intre numarul de cazuri si cel al zilelor de spitalizare, exista regiuni de dezvoltare care surprind global prin deficitul de cazuri dar exces de zile de spitalizare. ConcluziiExista variatii de practica in ingrijirile spitalicesti, care trebuiesc masurate si analizate din punct de vedere al cauzelor, si prevenite, prin monitorizarea nevoilor de servicii, raportarii datelor, precum si prin evaluarea atenta a structurilor si resurselor alocate
