1. Social deprivation in Danish primary care – presentation of an index
Peter Vedsted
Senior researcher, PhD.
The Research Unit for General Practice
Aarhus University
Denmark

2. Consequences of deprivation
Lower socio-economic position (SEP) is associated with:
Higher exposure to risk factors
Higher incidence of diseases
Delayed diagnose
Lower quality of treatment and follow-up
Higher mortality
Thus:
Providing health care for patients with low SEP require that GPs work harder and smarter!
Is the health care system supporting this (e.g. fair payment of GPs)?

3. Danish general practice
Free access to GP who is frontline and gatekeeper
‘General practice in Denmark guarantees free and equal access to medical advice’
However, we see:
Lack of GPs in deprived areas
GPs in deprived areas do not have enough time, skills and help
Have we busted the Danish model with equal access?!

4. Danish Deprivation Index (DADI)
AIM:
to provide an index of deprivation in Danish general practice
Method:
All inhabitants have unique personal identification numbers (CPR)
National database with socio-economic variables (Statistics Denmark)
8 key variables included in the index
Each practice characterised according to the variables with a sum-score
DADI made in collaboration with:
Torben Højmark Sørensen and Kim Rose Olsen, DSI, Denmark

5. Danish Deprivation Index (DADI)
Variables 1
Proportion of aged unemployed for at least 6 months 2
Proportion of aged with no professional education 3
Proportion of aged with low* income (adjusted to family size) 4
Proportion of aged with a transfer income/benefits 5
Proportion of children (0-16) from families with no professional education 6
Proportion of immigrant/descendents from non-western countries 7
Proportion of 30+ year living alone 8
Proportion of 70+ year with low* income
* lowest national quartile

6. Example of variable from DADI 2.189 practices in 2006
Proportion of aged with low income
Proportion of practice

7. Sum score of DADI
Each variable divided into 10 pieces -> 1-10 points
Each variable weighted according to importance
A DADI sum score for a practice population is made (10-90)

8. Danish Deprivation Index (DADI) 2189 practices%

9. Consequences for list size and earning
For every 10 points on DADI:
Number of listed patients per GP decreases by 50
Earning decreases by 35,000 DKR per GP per year
Example; 2 solo practices with DADI score 30 and 70, respectively
+200 patients
+140,000 DKR in remuneration
Preliminary data from DADI study: Kim Rose Olsen, Torben Højmark Sørensen, DSI, Denmark

10. Conclusion We are able to measure deprivation in each Danish practice
Number of listed patients per GP and earnings decreases significantly when deprivation increases
A group of practices have high deprivation scores
This challenges:
The willingness of GPs to work in deprived areas
A fair remuneration of GPs
Equality in health care from general practice

12. Sum-score from the 8 variables Variable divided into deciles
Example:
Variable with values from to 0.630
Difference divided into 10 exact equal parts (0.059 each)
Example (Proportion of aged unemployed for at least 6 months)
Interval
0.040 -
0.099
0.158
0.217
0.276
0.335
0.394
0.453
0.512
0.571
0.630
Point 1 2 3 4 5 6 7 8 9 10
Point 1 2 3 4 5 6 7 8 9 10
Practices
111
557
753
434
188 78 37 16 12

13. Danish Deprivation Index (DADI)
Variable
Weight 1
Proportion of aged unemployed for at least 6 months
0.100 2
Proportion of aged with no professional education
0.125 3
Proportion of aged with low income (adjusted to family size) 4
Proportion of aged with a transfer income/benefits 5
Proportion of children (0-16) from families with no professional education
0.150 6
Proportion of immigrant/descendents from non-western countries
0.250 7
Proportion of 30+ year living alone
0.075 8
Proportion of 70+ year with low income (lowest national quartile)
Total
1.000

14. Danish general practice
Tax financed health care system
2,200 general practices with 3,500 GPs
GPs are responsible for own practice
Contract with health insurance, 75% fee-for-service, 25% capitation
List system with 98% of population registered
1,550 listed persons per GP