Health Care Management

Challenging Inequities in Health and Health Care (CHeC)


Although the association of lower socioeconomic status with detrimental health and socioeconomic inequalities in the access to health services are well documented in the literature, evidence on the development of extent and determinants of health inequalities over time seems still scarce. Further, only little is known about the question how inequalities in access to health services can explain inequalities the actual utilisation. To answer this particular question, research must go beyond a simple analysis of health services utilisation and address the direct measurement of access. The Junior Research Group CHeC aims to widen the empirical basis and to contribute to a better understanding of health inequalities. The members of the BMBF Junior Research group are Leonie Sundmacher, Martin Siegel and Verena Vogt.

  • Head of the BMBF Junior Research Group CheC
    Leonie Sundmacher 
  • Members of the BMBF Junior Research Group CHeC
    Martin Siegel and Verena Vogt
  • Students involved in the BMBF Junior Research Group CHeC
    Katarina Witzheller and Benjamin Voigt


The major aim is a systematic gathering of evidence on extent and causes of health inequalities and to report results in comprehensible summaries and key figures. The findings are intended to provide an empirical basis for policy makers to conceive strategies for reducing health inequalities and improving health and access to health services. Specifically, the research tasks in the CHeC project are:

A: Longitudinal analyses of income-related health inequalities

Task A addresses possible changes in the extent and determinants of income-related health inequalities over the recent years using longitudinal data. The first study demonstrates tht income-related health inequalities increased particularly between 2005 and 2007, which can largely be explained by increased contributions of income, unemployment, and education (read more). Task A is partly conducted in cooperation with the EvaluateCareCVD project.

B: Determinants of Health Inequalities

Task B addresses the impact of health care services on several public health indicators with a focus on avoidable mortality and ambulatory-sensitive inpatient cases. Developments of the association of health care services and individual socioeconomic characteristics with avoidable mortality and ambulatory-sensitive inpatient cases over time are addressed using panel regression techniques. The definitions of ambulatory-sensitive cases and avoidable mortality are scrutinised and refined where necessary.

C: Health Inequalities and Responsiveness in ambulatory health care services

Task C addresses possible relations between individual socio-economic status and responsiveness in the outpatient sector as a collaborative research project in cooperation with the Responsiveness Project (RAC). The results from hierarchical regression models are used to decompose observed inequalities into the contributions of the explaining variables. The analyses has a principal focus on the demand for "equal quality of health care for all".

D: Inequalities in access to health care services

Task D addresses inequalities in the access to health care services in both, the inpatient and outpatient sectors in cooperation with the EMSiG-project. Inequalities in the access to pre-clinical ambulance services are evaluated with respect to the notion of horizontal equity (i.e. individuals in equal need should receive equal treatment regardless of socioeconomic or other non-need factors).

E: Reducing health inequalities through Telemedicine

Task E addresses the effect of Telemedicine measures on income-related health inequalities in cooperation with the EvaluateTelemedicine project. The assumption that Telemedicine may reduce health inequalities by improving compliance and facilitating access to health care services will be scrutinised in the framework of a controlled clinical trial.