Assessing, characterizing and communicating healthcare barriers

Background and objectives: Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies. We present and exemplify methods that may help augment such research. Methods: Methods were devised, refined or borrowed from allied disciplines including econometry and clinical epidemiology. Specifically, a patient perspective was adopted, longitudinally oriented hurdle models were used, and risk advancement periods were applied in health-care epidemiology. The example is that of migraine, specifically with regard to access to sumatriptan (MediPlus database, IMS Health). The perspective is that of the individual and of the country. Results: Patients with statutory health insurance had less than half the chance of receiving sumatriptan instead of conventional migraine attack medications from their general practitioners compared to their fully privately insured counterparts. However, the few statutorily and privately insured patients who received the triptan were then provided about equally with it. Due to the high proportion of people with statutory health insurance in the population, nearly 60% of the population-wide attainable health benefit of triptan therapy was lost. Transposed on a time axis, the access to these benefits of triptan therapy for migraine patients lagged behind by nearly one and a half years in the statutory healthcare system and in Germany as a whole. Conclusion: The framework extends traditional methods and may serve as a model for quantifying barriers to receipt of services under different policies. In the application example, healthcare resources recommended by professional bodies were inequitably distributed.