title: [Social inequality in medical rehabilitation].
abstract: BACKGROUND
  The analysis of inequalities in health care provision in Germany is of high sociopolitical relevance. For medical rehabilitation, which is an essential part of health care provision, only a few studies exist.
  
  
  OBJECTIVE
  With the example of psychosomatic and orthopedic medical rehabilitation, the present article investigates how features of social inequality influence different aspects of medical rehabilitation.
  
  
  METHODS
  The database consists of a written survey on the quality assurance of medical rehabilitation in northern Germany that includes 687 patients aged between 21 and 87 years. Aspects of the access to rehabilitation (e.g., the motivation for application), the process (participation in therapies) and the outcomes (e.g., subjective health and occupational risk) of rehabilitation were investigated in relation to social inequality. Social inequality was measured by means of a social class index. For the analysis, Chi-squared tests, t tests and a repeated measures analysis of variance, adjusted for sex and age, were conducted.
  
  
  CONCLUSIONS
  Initially, the analyses indicate that social inequality is of minor importance for access to rehabilitation and processes within rehabilitation. As subjective health is unequally distributed at the beginning of rehabilitation, however, equal treatment has to be discussed critically in terms of demand-driven treatment. In rehabilitation outcome distinct differences between social classes exist. To reduce these differences, rehabilitation aftercare close to the individual's living environment is necessary, which promotes the empowerment of vulnerable social groups in burdensome living conditions.
authors.affiliation: Fachbereich Rehabilitation, Institut für Sozialmedizin und Epidemiologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Haus 50, 23562, Lübeck, Deutschland. ruth.deck@uksh.de.
authors.forename: Ruth
authors.initials: R
authors.lastname: Deck
authors.affiliation: Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hofreuter-Gätgens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D012046:Rehabilitation / Q000706:statistics & numerical data*; D064890:Social Determinants of Health / Q000706:statistics & numerical data*; D012931:Social Environment; D012933:Social Identification; D012959:Socioeconomic Factors; D014600:Utilization Review; D055815:Young Adult
keywords: Ability to work; Medical rehabilitation; Social inequality; Subjective health; Utilization