Introduction. Public systems of heath care consider the equal public access to medical services provided without any unnecessary delay, as priority. However, because of many limitations (technical, financial or staffing) it is impossible to render all services without limit and to the same extent in differently populated administrative units – places of residence. The objective of the study was to obtain information on the accessibility to medical care services in the opinions of patients
living in small, mediocre and large communities, and in the capitals of regions.
Material and methods. The study covered 14,769 patients, aged 20-74, participating in a Multi-Centre National Study of State of Health – WOBASZ performed in 2003-2005. The research was conducted by means of an authorial questionnaire. Chi-square test was used to verify the statistical hypotheses on the equality of frequencies.
Results. The total annual morbidity among the Polish population aged 20-74 was 66.5% in males and 77.7% in females, and displayed an upward tendency with the size of community – from 61.6% in males and 74.8% in females living in the rural areas, to 72.4% and 83.8%, respectively, among males and females living in the capitals of regions. Annually, 63.6% of males and 75% of females used medical advice. Similar to morbidity, the percentage of patients increased with the size of commune, from 58.9% in males and 72.4% in females in small communities, to 69.8% and 81.8%, respectively, in big towns. The accessibility to medical services remained on the same level, irrespective of the size of community, and was ca. 97% in males and females. The difficulty in obtaining a medical appointment was reported by ca. 1% of males living in small and mediocre communities, and ca. 1.5% of inhabitants of large communities. This difficulty was reported by nearly 1.5% of females in all communities. The frequency of using advice of primary health care physician decreased with the size of commune, both among males and females - from 85.5% of males and 86.9% of females in rural communes, to 76.6% and 76.5%, respectively, in large cities. At the same time, an increase was noted in the percentage of patients reporting to private outpatient departments - from 2.9% in males and 5.2% in females to 4.2% and 6.4%, respectively. The annual hospital morbidity was 12.7% and remained the same, independently of the size of community and gender.
Conclusions. (1) The hospital morbidity rate did not depend on the size of administrative units or gender. (2) The percentage of patients seeking medical services increased with the size of the administrative unit. Females more frequently than males made medical appointments. (3) A low percentage of patients had difficulties with making a medical appointment, this percentage being the highest in large communes. Simultaneously, the inhabitants of large communes more often failed to use medical services due to the lack of time. (4) The annual morbidity among the Polish population aged 20-74 is high, significantly higher among females than males. (5) The larger the size of the commune the lower the frequency of using PHC services, and the higher the rate of reporting to a specialist outpatient department.