Does "Rural" Always Mean the Same? Macrosocial Determinants of Rural Populations' Health in Poland

A longitudinal study of perceived social position and health-related quality of life

BACKGROUND

A large body of evidence suggests that there is a social gradient in the association between perceived social position and various health outcomes. Yet only a fraction of this research uses longitudinal data, and these studies usually rely on two data points in time, consider a single health outcome measure, overlook non-linear effects of perceived social position, and come almost exclusively from the Western welfare democracies.

METHODS

Using data for 1921 individuals from three waves (2008, 2013, 2018) of the Polish Panel Survey (POLPAN), we fit between- and within-individuals hybrid-effects models with cluster-robust standard errors to investigate the association between one's perceived social position (self-placement on a socioeconomic hierarchy scale varying 1 to 10) and subsequent health-related quality of life (HRQoL) measured using the Nottingham Health Profile (NHP) and its six components.

RESULTS

We find that the association between perceived social position and health-related quality of life is larger when estimated between individuals than within individuals, yet in fixed- and hybrid-effects models perceived social position remains significantly and negatively linked with both the aggregated NHP measure as well as with its components such as emotional reaction, physical abilities, sleep, and social isolation. We also identify that starting to perceive oneself at the lower end of the social hierarchy is associated with a deteriorating health-related quality of life but a change at the top of the perceived social hierarchy is not linked with an improvement in NHP scores.

CONCLUSIONS

We provide new evidence on the significant and non-linear links between perceived social position and health-related quality of life and highlight possible pathways linking these two aspects of individuals' lives.

Inequity in the Access to eHealth and Its Decomposition Case of Poland

The aim of this research is to analyze the disparities in the distribution of information and communication technologies and skills across geographically determined population groups and to identify the source of the inequity. Literature showed that the nature of e-Health has the potential to resolve health inequalities. However, its successful implementation depends on such factors as the accessibility of required technologies to all people, the existence of technical infrastructure as well as people having the necessary information and communication skills. Employment of the Theil index allowed us to measure and decompose the national inequality into both: between and within macro-regions differences. Data was collected from Statistics Poland. The results showed the existence of inequity and its drivers. The novelty of this research results from application of the Theil index in the field of eHealth and identification of the barrier in access to e-Health, which can be a basis for improvement in government policy.

Does perceived social mobility affect health? Evidence from a fixed effects approach

RATIONALE

The question as to whether changing one's socioeconomic position over the life course affects health has not been answered in a conclusive manner. At the same time, it has been established that individuals who think of themselves that they are higher in the social hierarchy are healthier than those who think otherwise.

OBJECTIVE

In this study, we focus on perceived social mobility to shed new light on the issue of how social mobility affects health. We examine whether perceived social mobility, i.e., an individual's appraisal of doing better or worse than their parents, affects health by analyzing longitudinal data from Poland.

METHODS

Using a fixed effects approach to account for all time-invariant and important time-varying confounders, we analyze the Polish Panel Survey which has been collecting data on participants' social mobility perceptions along with information on their self-reported physical health and psychological wellbeing.

RESULTS

We find that perceived social mobility is a significant predictor of self-reported physical health and psychological wellbeing, even in models that adjust for a host of theoretically relevant control variables. The results demonstrate that upward subjective mobility has a consistent and strong positive effect on health outcomes. The effect of perceived social mobility is stronger for males and for those with less advantageous social origins.

CONCLUSIONS

Our findings are in line with the "from rags to riches" theoretical perspective, emphasizing the positive implications of upward social mobility on health through various psychological mechanisms. Based on our findings, we call for greater scholarly attention to subjective aspects of social mobility in research on health outcomes.

Social Mobility, Health and Wellbeing in Poland

Recently there has been a surge of interest in the consequences of intergenerational social mobility on individuals' health and wellbeing outcomes. However, studies on the effects of social mobility on health, using high-quality panel survey data, have almost exclusively been conducted in Western welfare democracies. To account for this gap, and using empirical data from one of the largest and most eventful post-communist countries, Poland, in this study we investigate how individuals' origin and destination socio-economic position and social mobility are linked to self-rated health and reported psychological wellbeing. We use the Polish Panel Survey (POLPAN) data to construct self-rated health and psychological wellbeing measures, origin, destination and occupational class mobility variables, and account for an extensive set of sociodemographic determinants of health. We employ diagonal reference models to distinguish social mobility effects from origin and destination effects, and account for possible health selection mechanisms. Our results suggest that there is an occupational class gradient in health in Poland and that both parental and own occupational class matter for individual health outcomes. We also find a positive reported psychological wellbeing effect for upward social mobility from the working to the professional class.

Patient Satisfaction Determinants of Inpatient Healthcare

The aim of the study was to analyse and evaluate the determinants influencing the overall satisfaction of patients with inpatient healthcare in the conditions of the Czech Republic. A total of the 1425 patients, who experienced hospitalisation and agreed to participate, were questioned in the study. A research questionnaire was used to obtain data on satisfaction with hospitalisation. The subject of the research consisted of the indicators related to the following factors: (i) satisfaction with the hospital, clinic, room and meals; (ii) satisfaction with medical staff-nurses, physician expertise and other staff; (iii) the quality of the treatment provided; (iv) satisfaction with leaving the hospital. The formulated statistical hypotheses were evaluated through structural equation modelling. The results of the analyses brought interesting findings. Satisfaction with medical staff is the most significant factor which has a positive effect on satisfaction with hospitalisation. Physician expertise (with trust and good communication skills) is more important for patients than satisfaction with nurses or other staff. The results obtained from the study represent valuable information for policymakers, regional healthcare plans, as well as for managers of hospitals.

Socioeconomic Determinants of Health and Their Unequal Distribution in Poland

The purpose of this study is to identify inequities in the distribution of socioeconomic determinants of health within Poland and their impact on the health status of Poles, as measured by mortality rate. We hypothesised that (1) there are inequities in the socioeconomic characteristics within geographically defined population groups and (2) some socioeconomic determinants of health have a particularly strong impact on the health status of Poles. Poland is administratively divided into three levels: voivodeships, powiats and gminas. We used a dataset covering all 380 powiats in Poland for the year 2018. We employed a two-stage nested Theil index and Herfindahl–Hirschman Index. In order to identify which of these determinants has the strongest impact on health, we conducted a regression analysis. The study revealed some inequities in the distribution of socioeconomic determinants of health. The mortality rate can be partly understood from variations within voivodeships in the distribution of health determinants. Important national inequalities were found in the case of two determinants, which simultaneously proved their significant impact on Poles’ health in the regression analysis. Thus, type of employment and access to modern infrastructure should be of particular concern for public authorities.

Financial balance of home nursing care providers in the Czech Republic

BACKGROUND

To enable people to live in old age in their own homes often requires specialised home care services. Despite the high importance of these services, the finance of home nursing care (HNC) is still under-investigated in many countries. The aim of this paper was to describe the finance of HNC in the Czech Republic.

METHODS

Balancing of revenues and costs was done using structured questionnaires from the closed accounting year 2018 as a monthly average. Nonparametric Kruskal-Wallis and Wilcoxon signed ranks tests were used to test hypotheses.

RESULTS

Data from 62 providers were analysed. The data included information from a total of 2297 patients and 995 employees. The average of total costs were € 17,591.7 (95% CI 14,175.3 - 21,008.1) and average of total revenues were € 17,276.5 (95% CI 13,923.5 - 20,629.5). The average cost per a patient was € 516.0 (95% CI 465.9-566.1) and the average revenues were € 500.1 (95% CI 457.0-543.3).

CONCLUSIONS

The overall financial balance of HNC providers seems to be balanced in the Czech Republic. Nevertheless, insurance, although it should, did not cover all the costs. Micro- providers tended to be cheaper regarding the hours worked by nurses.