Healthcare Quality Assessments: No Guarantees of Same Outcomes for Different Socioeconomic Stroke Patients.

BACKGROUND Health care quality assessment is being conducted in many countries. However, although improving health equity is one of the major objectives of medical quality assessment, it is not clear whether different socioeconomic statuses shows the same health outcomes even in the same medical quality hospitals. No study has directly compared the health outcomes of different socioeconomic status in the same hospitals nationwide. In this study, we tried to determine whether the mortality rate of acute stroke patients differs according to socioeconomic status. METHODS This study was a retrospective, observational study of patients who were subject to acute stroke quality assessment in 2013. A total of 10399 stroke cases were included in the study. When evaluating the mortality rate, the researchers analysed 10228 cases, after excluding 171 cases that were measured twice for the same person. The levels of socioeconomic status were divided according to the use of medical benefits, either National Health Insurance (NHI) for general populations or Medical Aid (MA) for the vulnerable. The primary outcomes according to socioeconomic status were measured in-hospital and at a one-year follow-up of the mortality of stroke patients. The secondary outcome was the composite performance score. RESULTS MA recipients had a higher in-hospital mortality rate (12.5% vs. 8.3%, p <0.001) and one-year follow-up mortality (14.9% vs. 10.8%, p-value <0.001) than NHI subscribers. MA recipients had slightly lower scores than NHI subscribers (83.2 vs. 84.4, p-value 0.02). In the same grade, MA recipients had lower performance scores than NHI subscribers, although the difference was not statistically significant. CONCLUSIONS There is a difference in mortality and healthcare performance according to socioeconomic status in stroke patients in Korea. Efforts to improve equity are needed, including development and monitoring of equality indicators and developing policies for healthcare equity.