{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:29:49Z","timestamp":1753892989175,"version":"3.41.2"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T00:00:00Z","timestamp":1706054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Spatially segregated, socio-economically deprived communities in Europe are at risk of being neglected in terms of health care. In Hungary, poor monitoring systems and poor knowledge on the health status of people in these segregated areas prevent the development of well-informed effective interventions for these vulnerable communities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We used data available from National Health Insurance Fund Management to better describe health care performance in segregated communities and to develop more robust monitoring systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study using 2020 health care data was conducted on each general medical practice (GMP) in Hungary providing care to both segregated and nonsegregated (complementary) adult patients. Segregated areas were mapped and ascertained by a governmental decree that defines them as within settlement clusters of adults with low level of education and income. Age, sex, and eligibility for exemption certificate standardized indicators for health care delivery, reimbursement, and premature mortality were computed for segregated and nonsegregated groups of adults and aggregated at the country level. The ratio of segregation and nonsegregation specific indicators (relative risk, RR) was computed with the corresponding 95% confidence intervals (95% CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Broad variations between GMPs were detected for each indicator. Segregated groups had a significantly higher rate of health care service use than complementary groups (RR\u2009=\u20091.22, 95% CI: 1.219;1.223) while suffering from significantly reduced health care reimbursement (RR\u2009=\u20090.940, 95% CI: 0.929;0.951). The risk of premature mortality was significantly higher among segregated patients (RR\u2009=\u20091.184, 95% CI: 1.087;1.289). Altogether, living in a segregated area led to an increase in visits to health care services by 18.1% with 6.6% less health spending.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adults living in segregated areas use health care services more frequently than those living in nonsegregated areas; however, the amount of health care reimbursement they receive is significantly lower, suggesting lower quality of care. The health status of segregated adults is remarkably lower, as evidenced by their higher premature mortality rate. These findings demonstrate the need for intervention in this vulnerable group. Because our study reveals serious variation across GMPs, segregation-specific monitoring is necessary to support programs sensitive to local issues and establish necessary benchmarks.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1152555","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T04:30:26Z","timestamp":1706070626000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Cross-sectional comparison of health care delivery and reimbursement between segregated and nonsegregated communities in Hungary"],"prefix":"10.3389","volume":"12","author":[{"given":"Feras","family":"Kasabji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ferenc","family":"Vincze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kinga","family":"Lakatos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anita","family":"P\u00e1link\u00e1s","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3","family":"K\u0151r\u00f6si","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3","family":"Ulicska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"K\u00f3sa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00f3za","family":"\u00c1d\u00e1ny","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00e1nos","family":"S\u00e1ndor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.2105\/AJPH.2010.300058","article-title":"Environmental health disparities in housing","volume":"101","author":"Jacobs","year":"2011","journal-title":"Am J Public Health"},{"year":"2013","key":"ref2"},{"year":"2013","key":"ref3"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1093\/epirev\/mxp001","article-title":"Is segregation bad for your health?","volume":"31","author":"Kramer","year":"2009","journal-title":"Epidemiol Rev"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/acprof:oso\/9780195138382.001.0001","volume-title":"Neighborhoods and health","author":"Kawachi","year":"2003"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1016\/j.socscimed.2004.08.040","article-title":"Racial residential segregation and geographic heterogeneity in black\/white disparity in poor self-rated health in the US: a multilevel statistical analysis","volume":"60","author":"Subramanian","year":"2005","journal-title":"Soc Sci Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1038\/s41390-019-0513-6","article-title":"The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families","volume":"87","author":"Beck","year":"2020","journal-title":"Pediatr Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1016\/S0277-9536(00)00016-2","article-title":"Residential segregation and the epidemiology of infectious diseases","volume":"51","author":"Acevedo-Garcia","year":"2000","journal-title":"Soc Sci Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3390\/ijerph15040588","article-title":"Roma housing and eating in 1775 and 2013: a comparison","volume":"15","author":"Kozubik","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1136\/jech.2009.092098","article-title":"Predictors of health-endangering behaviour among Roma and non-Roma adolescents in Slovakia by gender","volume":"64","author":"Kolar\u010dik","year":"2010","journal-title":"J Epidemiol Community Health"},{"key":"ref11","first-page":"270","volume-title":"Roma in an expanding Europe: Breaking the poverty cycle","author":"Ringold","year":"2005"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"139","DOI":"10.21101\/cejph.a3661","article-title":"Health inequalities of the Roma in Europe: a literature review","volume":"19","author":"Parekh","year":"2011","journal-title":"Cent Eur J Public Health"},{"year":"","key":"ref13"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1093\/eurpub\/ckp097","article-title":"Environmental survey of segregated habitats of Roma in Hungary: a way to be empowering and reliable in minority research","volume":"21","author":"K\u00f3sa","year":"2011","journal-title":"Eur J Pub Health"},{"year":"2004","key":"ref15"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1093\/eurpub\/ckv057","article-title":"Seven years\u2019 mortality in Roma and non-Roma patients after coronary angiography","volume":"25","author":"Sudzinova","year":"2015","journal-title":"Eur J Pub Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3620","DOI":"10.3390\/ijerph16193620","article-title":"Prevalence of chronic diseases and activity-limiting disability among Roma and non-Roma people: a cross-sectional, census-based investigation","volume":"16","author":"Vincze","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1093\/eurpub\/ckx226","article-title":"Gypsy, Roma and Traveller access to and engagement with health services: a systematic review","volume":"28","author":"McFadden","year":"2018","journal-title":"Eur J Pub Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s00038-013-0451-8","article-title":"Are barriers in accessing health services in the Roma population associated with worse health status among Roma?","volume":"58","author":"Jarcuska","year":"2013","journal-title":"Int J Public Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s12939-016-0327-7","article-title":"Accessible health care for Roma: a gypsy\u2019s tale a qualitative in-depth study of access to health care for Roma in Ghent","volume":"15","author":"Hanssens","year":"2016","journal-title":"Int J Equity Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00038-011-0312-2","article-title":"Research on Roma health and access to healthcare: state of the art and future challenges","volume":"57","author":"F\u00f6ldes","year":"2012","journal-title":"Int J Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1093\/eurpub\/ckw004","article-title":"An examination of unmet health needs as perceived by Roma in central and Eastern Europe","volume":"26","author":"Arora","year":"2016","journal-title":"Eur J Pub Health"},{"year":"2011","key":"ref23"},{"key":"ref24","first-page":"1","article-title":"Challenges facing researchers on Roma minorities in contemporary Europe","volume-title":"European Centre for Minority Issues (ECMI): 19","author":"Tremlett","year":"2013"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1097\/01.ede.0000258919.15281.4f","article-title":"Studying vulnerable populations: lessons from the Roma minority","volume":"18","author":"K\u00f3sa","year":"2007","journal-title":"Epidemiol Camb Mass"},{"volume-title":"Communication from the commission to the European Parliament, the council, the European economic and social Committee of the Regions: An EU framework for National Roma Integration Strategies up to 2020","year":"2011","key":"ref26"},{"key":"ref27","first-page":"1","article-title":"Hungary health system review","volume":"13","author":"Gaal","year":"2011","journal-title":"Health Syst Transit"},{"year":"2019","key":"ref28"},{"volume-title":"National Social Inclusion Strategy and the government action plan on its implementation between 2015 and 2017","year":"2015","key":"ref29"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e027296","DOI":"10.1136\/bmjopen-2018-027296","article-title":"The impact of general practitioners\u2019 gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study","volume":"9","author":"Kov\u00e1cs","year":"2019","journal-title":"BMJ Open"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3153","DOI":"10.3390\/ijerph16173153","article-title":"Factors associated with practice-level performance indicators in primary health Care in Hungary: a Nationwide cross-sectional study","volume":"16","author":"Kov\u00e1cs","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1835","DOI":"10.3390\/ijerph15091835","article-title":"Healthcare utilization and all-cause premature mortality in Hungarian segregated Roma settlements: evaluation of specific indicators in a cross-sectional study","volume":"15","author":"S\u00e1ndor","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1007\/s40200-021-00878-0","article-title":"Public health interventions on prescription redemptions and secondary medication adherence among type 2 diabetes patients: systematic review and meta-analysis of randomized controlled trials","volume":"20","author":"Bekele","year":"2021","journal-title":"J Diabetes Metab Disord"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1093\/eurpub\/cku157","article-title":"Prevalence of metabolic syndrome among Roma: a comparative health examination survey in Hungary","volume":"25","author":"K\u00f3sa","year":"2015","journal-title":"Eur J Pub Health"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"853","DOI":"10.2105\/AJPH.2005.072173","article-title":"A comparative health survey of the inhabitants of Roma settlements in Hungary","volume":"97","author":"K\u00f3sa","year":"2007","journal-title":"Am J Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1007\/s00038-017-0954-9","article-title":"The decade of Roma inclusion: did it make a difference to health and use of health care services?","volume":"62","author":"S\u00e1ndor","year":"2017","journal-title":"Int J Public Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1093\/eurpub\/ckl040","article-title":"Use of health care services by ethnic minorities in the Netherlands: do patterns differ?","volume":"16","author":"Uiters","year":"2006","journal-title":"Eur J Pub Health"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2276-2","article-title":"Health literacy and primary health care use of ethnic minorities in the Netherlands","volume":"17","author":"van der Gaag","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1093\/eurpub\/ckx113","article-title":"Avoidable hospitalization among migrants and ethnic minority groups: a systematic review","volume":"27","author":"Dalla Zuanna","year":"2017","journal-title":"Eur J Pub Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1111\/j.1475-6773.2009.00977.x","article-title":"Racial segregation and disparities in health care delivery: conceptual model and empirical assessment","volume":"44","author":"Vaughan Sarrazin","year":"2009","journal-title":"Health Serv Res"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1007\/s00038-018-1134-2","article-title":"Why don\u2019t segregated Roma do more for their health? An explanatory framework from an ethnographic study in Slovakia","volume":"63","author":"Belak","year":"2018","journal-title":"Int J Public Health"},{"year":"1999","key":"ref42"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s11357-020-00195-z","article-title":"Nursing homes and the elderly regarding the COVID-19 pandemic: situation report from Hungary","volume":"42","author":"Kemenesi","year":"2020","journal-title":"GeroScience"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2258","DOI":"10.3390\/ijerph19042258","article-title":"The effect of the COVID-19 pandemic on the social inequalities of health care use in Hungary: a nationally representative cross-sectional study","volume":"19","author":"Bekele","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e0264363","DOI":"10.1371\/journal.pone.0264363","article-title":"COVID-19 vaccination coverage in deprived populations living in segregated colonies: a nationwide cross-sectional study in Hungary","volume":"17","author":"S\u00e1ndor","year":"2022","journal-title":"PLoS One"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1152555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T04:30:36Z","timestamp":1706070636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1152555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2024.1152555"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1152555","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2024,1,24]]},"article-number":"1152555"}}