Health services accessibility among Spanish elderly

[Lack of access and the trajectory of healthcare use by elderly Brazilians]

Populational ageing is a current phenomenon and calls for the reconfiguration of health services and expansion of access for the elderly. This is a cross-sectional study with 6,624 elderly Brazilians over 60 that set out to evaluate access to healthcare by measuring lack of access and by describing the trajectory until recourse to hospitalization, emergency care and medical visits. The variables were analyzed according to the nature of funding to access the service (SUS, private insurance and cash-payment). The prevalence of lack of access was 2.5% (CI95% 1.6;4.0) for hospitalizations, 2.1% (CI95% 1.4; 3.1) for emergency rooms, and 0.6% (CI95% 0.3;0.9) for medical visits. SUS accounted for most of the care provided. Positive aspects of SUS were the higher number of medical visits in the city of residence and less money spent on transport. The private system stands out for the low frequency of long waiting times and higher frequency of referrals to return visits after hospitalization. The findings highlight the importance of SUS in Brazil in promoting equality and universality despite the existing deficiencies. In both public and private systems, greater articulation among the healthcare levels is required for integral healthcare to elderly individuals.

Challenges in ADHD care for ethnic minority children: A review of the current literature

While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.

Polypharmacy and Utilization of Health Care Services: A Cohort Study of People Aged Over 50 Years in Taiwan

This study aimed to understand the changes and correlation in the long-term trends of polypharmacy and the utilization of health care services in a population over the age of 50 years through the use of a national database. A total of 2813 subjects who participated in surveys in 1999, 2003, and 2007 were selected as the samples. Each subject was followed-up for the period of 9 years. From 1999 to 2007, the proportion of mild and severe polypharmacy cases increased from 41.5% (1999) to 51.3% (2003) and 57.1% (2007), respectively. This study found that the more severe the polypharmacy was, the higher the risk of health care service utilization would be. The Generalized Estimating Equation model of multivariate analysis showed that the incidence rate ratio of medical utilization increased with the severity of polypharmacy, as did the use of advanced medical resources (ie, the number of hospitalizations). In particular, the increase in incidence rate ratio was more significant in 3 aspects: (1) number of pharmacy visits; (2) number of emergency room admissions; and (3) number of hospitalizations. The government should establish policies and guidance for the safe use of medicines to ensure reduced risk for older people.

Smoking Status and Cost of Illness in Patients with Depressive Disorder Based on the National Health Survey in Spain

BACKGROUND

Twenty-one percent of subjects with depressive disorder (DD) smoke. This prevalence is expected to be related to healthcare resources utilization (HRU) and sick leave, thereby accounting for substantial costs to the National Health System (NHS) and to society that still need to be characterized. The objective was to estimate cost of illness in patients with DD according to their smoking status.

METHODS

We used the 2011/2012 National Health Survey to document HRU and lost-workday equivalents (LWDE). Men and women 18+ years old with a DD self-reported to a physician in the past 12 months were categorized into: smokers (daily smokers), former smokers, and never smokers. HRU and LWDE were computed on an annualized basis. Multivariate general linear models adjusted for sex, age, and comorbidities were applied.

RESULTS

Data from 1,816 subjects (381 smokers, 290 former smokers, and 1,145 never smokers) were analyzed. Smokers had higher total per patient annual costs (thousands, €3.14), and higher annual healthcare costs (€2.53) than former smokers (€2.35, p < .1; and €1.93, p < .05) and never smokers (€2.42, p < .05; and €2.06, p < .1): with excess costs of €0.79 and €0.72 for total annual costs and €0.60 and €0.47 for annual healthcare costs (p = .029 and p = .056, respectively).

CONCLUSIONS

Smoking DD subjects were associated with higher HRU and costs from both the societal and healthcare perspectives, when compared with former and never smokers in the Spanish general population. Supporting people with DD to quit smoking might therefore be a value-for-money health policy in Spain.

Accessibility to health services among migrant workers in the Northeast of Thailand

Background. There is an increasing trend of trans-border migration from neighboring countries to Thailand. According to human rights laws, everyone must have access to health services, even if they are from other nationalities.  However, a small minority of health personnel in Thailand discriminate against immigrant workers, as they are from a lower financial bracket. Methods. This cross-sectional study aims to determine the prevalence of accessibility to health services and factors associated with access to health services among migrant workers who work along the Northeast border of Thailand. A total of 621 legal migrant workers were randomly selected to respond to a structured questionnaire about the satisfaction of health services, using the 5As of health services: availability; accessibility; accommodation; affordability; acceptability.  Associations between independent variables and access to health services were analysed   using multiple logistic regression analysis. Results. The results indicated that the majority of these registered migrant workers were female (63.9%) with an average age of 29± 8.61 years old, and were married (54.3%). Most of the workers worked at restaurants (80%), whereas only 20% were in agricultural sectors. Only 14% (95% CI: 11-17%) of migrant workers had access to health services. The factors that were significantly associated with accessibility to health service experienced ill health during the past one year (OR = 2.48; 95%CI; 1.54-3.97; p-value<0.001) ; have been married (OR = 2.32; 95% CI: 1.40 - 3.90; p-value <0.001). Conclusions. Most of the migrant workers could not access health services. The ones who did access health services were married or ill.

Socioeconomic determinants of access to health services among older adults: a systematic review

OBJECTIVE

The objective of this study was to analyze the association between the socioeconomic characteristics and the access to or use of health services among older adults.

METHODS

This is a systematic review of the literature. The search has been carried out in the databases PubMed, LILACS and Web of Science, without restriction of dates and languages; however we have included only articles published in Portuguese, English, and Spanish. The inclusion criteria were: observational design, socioeconomic factors as variables of interest in the analysis of the access to or use of health services among older adults, representative sample of the target population, adjustment for confounding factors, and no selection bias.

RESULTS

We have found 5,096 articles after deleting duplicates and 36 of them have been selected for review after the process of reading and evaluating the inclusion criteria. Higher income and education have been associated with the use and access to medical appointments in developing countries and some developed countries. The same association has been observed in dental appointments in all countries. Most studies have shown no association between socioeconomic characteristics and the use of inpatient and emergency services. We have identified greater use of home visits in lower-income individuals, with the exception of the United States.

CONCLUSIONS

We have observed an unequal access to or use of health services in most countries, varying according to the type of service used. The expansion of the health care coverage is necessary to reduce this unequal access generated by social inequities.

Patients' Willingness on Community Health Centers as Gatekeepers and Associated Factors in Shenzhen, China: A Cross-sectional Study

The gate-keeping function of primary healthcare facilities has not been fully implemented in China. This study was aiming at assessing the willingness on community health centers (CHCs) as gatekeepers among a sample of patients and investigating the influencing factors.A cross-sectional survey was conducted in 2013. A total of 7761 patients aged 18 to 90 years from 8 CHCs in Shenzhen (China) were interviewed using a structured questionnaire. Descriptive and multivariable logistic regression analyses were used to analyze the characteristics of patients, their willingness on the gatekeeper policy, and identify the associated factors.On willingness of patients to select CHCs as gatekeepers, 70.03% of respondents were willing, 18.95% were neutral, and 9.02% were unwilling. Multivariable analysis indicated that female patients (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.02-1.30); patients with health insurance (OR = 1.21, 95% CI: 1.07-1.36); patients who lives near CHC (OR = 1.89, 95% CI: 1.17-3.05); and patients who were more familiar with the gatekeeper policy (OR = 2.09, 95% CI: 1.85-2.36), had higher level of willingness on the policy. Conversely, reporting with good health status was independently associated with the decreased willingness on gatekeeper policy (OR = 0.69, 95% CI: 0.53-0.90).The findings indicated that patients' willingness on CHCs as gatekeepers is high. More priority measures, such as expanding medical insurance coverage of patients, strengthening the propaganda of gatekeeper policy, and increasing the access to community health service, are warranted to be taken. This will help to further improve the patients' willingness on CHCs as gatekeepers. It is thus feasible to implement the gatekeeper policy among patients in China.

[Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class]

Objetivo

Conocer la utilización de servicios sanitarios de Atención Primaria (AP), Atención Especializada (AE), hospitalizaciones, Hospital de Día y Urgencias, y la hiperfrecuentación en ancianos en España, analizando la influencia del estado de salud, sexo, clase social y evolución temporal.

Diseño

Estudio transversal en 2 fases.

Emplazamiento

España.

Participantes

Personas encuestadas en la Encuesta Nacional de Salud 2006 y 2011-12.

Mediciones principales

Como variables de salud se utilizaron la salud percibida y diagnosticada (número y tipo de diagnósticos). La clase social se obtuvo a partir de la última ocupación del sustentador principal (clases manuales y no manuales). Se realizaron análisis de regresión logística, ajustando por sexo, edad, nivel de salud, clase social y año, calculando su capacidad predictiva.

Resultados

El porcentaje de población mayor que utiliza consultas médicas descendió en el periodo estudiado. Las mujeres trabajadoras manuales presentaron la mayor prevalencia de mala salud (mala salud percibida en el 2006: 70,6%). La mala salud se asoció a mayor utilización de servicios sanitarios. La salud percibida fue mejor predictor de utilización de servicios y de hiperfrecuentación que la diagnosticada, con la mayor capacidad predictiva para AE (C = 0,676). Los ancianos de clases sociales bajas utilizaron con más frecuencia AP y Urgencias, mientras que la utilización de AE y Hospital de Día fue mayor en clases altas.

Conclusiones

Existen diferencias en salud y utilización de servicios sanitarios en mayores según clase social. Resulta necesario prestar atención a la salud percibida como predictor de la utilización de servicios sanitarios y revisar la accesibilidad-equidad de nuestros servicios.

Trends in self-rated health status and health services use in COPD patients (2006-2012). A Spanish population-based survey

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients often have a significant impairment in their health status, which is an independent predictor of health services use.

OBJECTIVES

To describe the self-rated health status and the prevalence of health services use among COPD Spanish patients; to identify which factors are independently associated with a worse health status and a higher use of health services; and to study the time trends in the health status and prevalence of use of health services (2006-2012).

METHODS

Observational study: We analyzed data from the Spanish National Health Surveys conducted in 2006 and 2012. We included responses from adults aged 40 years or over. Subjects described their health status as very good, good, fair, poor, or very poor, which was dichotomized into very good/good or fair/poor/very poor self-perceived health status.

RESULTS

We identified 2,321 COPD patients. The percentage of patients with health status fair, poor, or very poor was 76.8 % in 2006 and 74.8 % in 2012 (p > 0.05). Regarding the health resources use, we observed a significant decrease in the number of visits to primary care over time in women (67.8 vs. 57.2 %, p < 0.05) and men (62.2 vs. 54.0 %, p < 0.05). However, we did not find improvement in the prevalence of emergency department visits or hospitalizations. Associated factors with a worse self-rated health status and a higher use of health services in women and men included: having three or more chronic diseases, presence of mental disorders, and absence of leisure time physical activity.

CONCLUSIONS

The current study revealed a decrease in the general practitioner visits, without changes in use of other health care services in the COPD Spanish population from 2006 to 2012. The self-rated health status did not changed significantly during this period.

What limits the utilization of health services among the rural population in the Dabie Mountains- evidence from Hubei province, China?

Background

Individuals living in rural mountain areas tend to use health services less to manage discomfort or illness. This study aims to identify the variables that best explain the health service utilization of a sample of the rural population in the Dabie Mountains in China.

Methods

To obtain information about health service utilization, a cross-sectional household survey was conducted using face-to-face interviews among the residents of a poor town in the Dabie Mountains. A total of 1,003 residents aged 15 or more, who had felt unwell in the last two weeks before the survey, were included in the analysis. The χ² test and binary logistic regression were used to analyze the factors influencing health service utilization.

Results

A total of 51.2% of those surveyed had not used health services when they felt unwell, higher than the data reported in the 4th National Health Services Survey of China. Enabling variables played an important role in predicting the utilization of health services. Factors associated with increased health service utilization included being younger, travelling longer to the nearest clinic, and higher household net income.

Conclusion

To reduce disparities in health service utilization, (1) some effort should be made to change the perceptions and attitudes of older people; (2) reimbursement levels of the New Rural Cooperative Medical Care System should be improved to reduce economic barriers to health service utilization.

The impact of age and sex on healthcare expenditure of households in Bangladesh

The impact of age and sex on health care expenditure has recently become one of the major concerns in many developing countries like Bangladesh. Age and sex differences in the use of health care services can be substantial at several stages of life which are reflected in overall healthcare expenditure.

We examined the impact of age and sex of the population on overall healthcare expenditure of households in Bangladesh.

A total of 10,705 populations who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. Sex and age group were considered as childhood (0–19), young adult (20–39), middle-aged adult (40–64), senior aged (65–84) and old senior aged (84+) for the entire analysis. Total healthcare expenditure was derived by considering direct cost such as physician’s fee, cost of medicine, diagnostic, transportation, tips and informal payment etc. Indirect and intangible cost was not considered in the analysis.

The study found that overall health care expenditure of male (US$ 11.5) is higher than female (US$ 11.2) while this is higher for female (US$ 14.2) than male (US$ 11.3) in the reproductive age. The highest health expenditure was observed in male (US$ 69.7) of age 65–69 years and in female (US$ 23.4) of age 75–79 years. The cost for hospitalization was significantly higher (US $23.7) for female than male (US$ 21.1). Overall health expenditure was observed to be significantly higher in elderly than younger people.

These findings provide an experimental framework for the continuing inquiry of equity in the allocation of health care expenditure between male and female at different age, which suggest current health care system in Bangladesh place a significant financial strain on the elderly population.

Has the prevalence of health care services use increased over the last decade (2001-2009) in elderly people? A Spanish population-based survey

OBJECTIVES

(1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001-2009.

STUDY DESIGN

Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n=21,058), 2003 (n=21,650), 2006 (n=29,478) and 2009 (n=22,188). We included responses from adults aged 65 years and older.

OUTCOME MEASURES

The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models.

RESULTS

The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P<0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39-1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27-1.61; men: OR 1.71, 1.49-1.97).

CONCLUSIONS

The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.

Decomposing differences in utilization of health services between depressed and non-depressed elders in Europe

Utilization rates of non-psychiatric health services are often higher in depressed compared to non-depressed adults. We examine whether these differences can be explained by the increased prevalence or the increased impact of demographic, socioeconomic, geographic, and health-related factors. The sample was taken from The Survey of Health, Ageing and Retirement in Europe (Wave 1 Release 2), a prospective observational study of 31,115 randomly selected people ages 50+ living in Austria, Germany, Sweden, the Netherlands, Spain, Italy, France, Denmark, Greece, Switzerland, Belgium, and Israel. Blinder-Oaxaca decomposition methods for multivariate linear regression models were used to estimate the influence of prevalence and impact of covariates on utilization among depressed and non-depressed participants. We find robust evidence that the gap in utilization between depressed and non-depressed can be accounted for by both prevalence (explained) and impact (unexplained) differences. The prevalence effect accounted for 57.7% whereas differences in the impact of covariates between depressed and non-depressed persons explained 42.3% of differences in utilization rates. Despite cross-national differences in quality and coverage of health services, in all countries, the prevalence effect was explained entirely by health measures, including: chronic diseases, functional mobility, painful symptoms, and self-reported health. The impact effect varied cross-nationally, but was largely explained by socioeconomic status and urbanicity. Hospitalization among depressed adults was twice that of non-depressed adults. Policies aimed at improving adherence and improving disease management among depressed adults should be explored.

Equitable Access to Health Care for the Elderly in South Korea

The aim of this study was to examine whether the principle of “equal treatment in equal need” was met in health care utilization in Korea regardless of income among the elderly. Using data from the Korean National Health and Nutrition Examination Survey for 1998, 2001, and 2005, the authors measured the horizontal inequity of health care utilization and identified the factors contributing to inequality. There were income-related inequalities favoring the better-off for both outpatient and inpatient care utilization among the elderly, for which illness variables and enabling variables of individuals were the most important contributing factors, respectively. In addition, there was horizontal inequity across socioeconomic subgroups in the utilization of both types of care, with significant inequities among the less educated and lower income groups. This study reveals that income-related inequities exist in health care utilization among the elderly and that financial resources are an important determinant of health care utilization despite universal coverage by national health insurance.

Differences Between Users and Nonusers of Day Care Centers Among Frail Older Persons in Israel

Day care centers are one of the core community-based services for frail older persons. The purpose of the study is to examine differences in characteristics of users and nonusers of day care centers among frail older people and factors that explain service utilization. Personal interviews are conducted with 333 respondents, of whom 81 were users. Based on the behavioral model of Andersen, the results show that both groups significantly differed in most predisposing (age, marital status), enabling (having a homecare worker), and need (IADL [instrumental activities of daily living]) factors. The findings lend support to Andersen’s behavioral model and suggest that further research is needed to assess underutilization of day care centers. Implications for research, policy, and practice are discussed.

Use of primary care services by elderly people with chronic conditions, Brazil

OBJECTIVE

To assess the use of healthcare services by elderly individuals suffering from chronic diseases.

METHODS

Cross-sectional study carried out with 2,889 individuals aged 65 years or more with chronic conditions - arterial hypertension, diabetes mellitus and mental illness -, living in catchment areas of primary care units in 41 cities of the South and Northeast regions of Brazil in 2005. The analyzed data were obtained in the baseline study of Programa de Expansão e Consolidação da Saúde da Família (Program for the Expansion and Consolidation of Family Health). The studied variables were sex, age, skin color, marital status, level of schooling, family income, smoking, functional disability, and care model of the primary care unit. The adjusted analysis of outcomes was performed by means of Poisson regression.

RESULTS

The prevalence of medical visit in the last six months was 45% in the South region and 46% in the Northeast region. The prevalence of participation in groups of educational activities in the last year was 16% in the South and 22% in the Northeast. In both regions, use of services was higher for elderly people under the age of 80 years, with low level of schooling and living in catchment areas of primary care units with Programa Saúde da Família (Family Health Program). Only in the South region did the elderly with functional disability have higher prevalence of medical visits.

CONCLUSIONS

The prevalence of medical visit and participation in groups of educational activities was low when compared to previous studies conducted with elderly individuals in Brazil. The results indicate that, although the Family Health Program promotes greater use of services at primary care units by elderly people with chronic conditions, it is necessary to expand the access of those aged over 80 and of individuals with functional disability.

Health services use by older people with disabilities in Spain: do formal and informal care matter?

As people grow older in late life, their need for help with the activities of daily living increases. In Spain, those who need such help constitute about 20 per cent of the population aged 65 or more years. Support may be from formal care, informal care or both, and the type has different consequences for care receivers and their social networks. The aim of this paper is to examine the relationship between informal and formal care and the use of health services among older people in Spain. Using a sample of 1,148 respondents aged 65 or more years from the Spanish National Health Survey of 2003, we analysed the association between the sources of care (formal, informal, both, or no care) and the frequency of three types of health-care utilisation: hospitalisation, emergency services and medical consultations. After controlling for sex, age, level of difficulty in the activities of daily living, self-perceived health status, and social class, it was found that older people with disabilities who received neither informal nor formal care were more likely to consult physicians than those who received informal care, but that there were no significant relationships between the type of care and health-services utilisation. The findings provide new information about the consequences of the different types of care of older people with disabilities, and suggest specifically that informal care substitutes for some tasks usually done by health professionals.

Inequalities in breast and cervical cancer screening among urban Mexican women

OBJECTIVE

To examine the equity of screening for breast and cervical cancer among women aged 50 and over living in Mexico City according to the Andersen behavioural model.

METHODS

Logistic regressions were used to analyze the associations of predisposing factors, enabling resources and health needs with mammography and Pap testing among 1323 women aged 50 and over living in Mexico City. The data were taken from SABE, a survey conducted in Latin American and Caribbean cities in 1999-2000.

RESULTS

Referring to the previous two years, use of mammography was less frequent (14.8%) than Pap testing (53.7%). Higher education and having private health insurance were associated with receiving both procedures. Being married was associated with receipt of Pap testing, while being unmarried was associated with mammography. Younger women were more likely to receive a Pap test. Other cancer prevention behaviours were strong predictors of mammography and Pap test use.

CONCLUSIONS

There are inequities in access to cancer screening services among women aged 50 and over in Mexico. Cancer prevention programs need to implement strategies that guarantee free and accessible services independently of social conditions or type of health insurance. The observed clustering of screening services suggests that packaging screening programs for gynaecological cancer could be used to increase coverage.

The utilization of dental care services according to health insurance coverage in Catalonia (Spain)

The aim of this study was to assess the relationship of dental care service use with health insurance and its evolution. The Catalan Health Interview Survey is a cross-sectional study conducted in 1994 (n = 15 000) and 2001-2 (n = 8400) by interviews at home to a representative sample of Catalonia (Spain). All the estimates were obtained by applying weights to restore the representativeness of the Catalonia general population. In the bivariate analysis, age, gender, social class and health insurance coverage were statistically associated with a dental visit in the previous year (P < 0.001). Analysis with logistic regression showed that health insurance status has a statistically significant association with utilization (P < 0.001), which was independent of the other socio-economic factors (age, gender, country of birth, and social class). However, the falling trend of differences by health insurance coverage is of note (adjusted OR = 2.2 and 1.5 at 1994 and 2002, respectively); as well as the positive evolution of the overall rate of dental service care use in the previous year, from 26.7% in 1994 to 34.3% in 2002. Future studies will be needed to monitor this tendency.

Prevalência de internação hospitalar e fatores associados: um estudo de base populacional em um centro urbano no Sul do Brasil

Este estudo transversal investiga a utilização de serviços hospitalares e fatores associados em indivíduos com 14 anos ou mais em Canoas, Rio Grande do Sul, Brasil. Foram entrevistados 1.954 indivíduos de 40 setores censitários. A prevalência de internação hospitalar no período de um ano foi de 9,4%. Na análise ajustada para as demais variáveis, as que permaneceram associadas a uma maior chance de hospitalização foram: idade de 60 anos ou mais (RP = 4,14; IC95%: 2,07-8,25), realização de consulta médica nos últimos dois meses (RP = 2,79; IC95%: 2,03-3,83), a ocorrência de dois ou mais eventos estressantes (RP = 1,83; IC95%: 1,19-2,80). A renda individual, de 2,10 salários mínimos ou mais, esteve associada a uma menor chance de hospitalização (RP = 0,60; IC95%: 0,41-0,87). A prevalência de internações encontrada é compatível com outros estudos. A maior prevalência de hospitalização nos grupos de menor nível sócio-econômico pode indicar um menor acesso aos serviços de atenção básica. Outros fatores envolvidos poderiam ser a maior morbidade e severidade da doença entre os grupos mais pobres. Salienta-se a importância de investigar a relação entre eventos estressantes e morbidade.

Gender differences in the utilization of health-care services among the older adult population of Spain

BACKGROUND

Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly.

METHODS

Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables.

RESULTS

As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07-1.44), received home medical visits (OR: 1.67; 95% CL: 1.34-2.10) and took > or = 3 medications (OR: 1.54; 95% CL: 1.34-1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of > or = 3 medications was 1.24 (1.06-1.45). After adjustment for HRQL, the OR was 1.03 (0.89-1.21) for visits to medical practitioners, 1.24 (0.98-1.58) for home medical visits, 0.71 (0.58-0.87) for hospitalization, and 1.14 (0.97-1.33) for intake of > or = 3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56-0.84).

CONCLUSION

The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women.

Factors associated with health care utilization by the elderly in a public health care system

OBJECTIVE

The objective was to determine the factors associated with the use of health care services by the elderly residing in the community.

METHODS

A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status.

RESULTS

The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41).

CONCLUSIONS

Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.

Access to rural health services: research as community action and policy critique

Although access to rural health services has been an enduring focus for a variety of scholars, little has been recorded about the intersection between health service policy, provision and access experiences. This paper identifies how community action can highlight the gaps between policy rhetoric and access experiences. Taking the case of rural New Zealand, we document how a community organisation Rural Women New Zealand (RWNZ) completed a national survey as a form of community action. This study records rural households' experiences and challenges when accessing both primary and secondary health services. A range of access problems is identified. The study also illustrates how community-based activism concerning health care need not be local or single-service focussed, but can involve a multi-service critique at the national scale. Such work highlights not only the experience but also the complexity and politics of health service access.

Gender and use of health care among older adults in Egypt and Tunisia

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls' excess mortality persists.

Home deliveries in Indonesia: who provides assistance?

Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.

Respiratory illness in the Dominican Republic: what are the predictors for health services utilization of young children?

Respiratory illness and diarrhoea continue to be the leading causes of paediatric morbidity and mortality in the Dominican Republic. An important first step in alleviating this disease burden is to understand patterns and predictors of health services utilization for these conditions. This study examines the predictors of (a) health services utilization, and (b) public versus private sector use, for respiratory illness in the under-five population in the Dominican Republic. The DHS-2 dataset (1991) was utilized for analysis. Logistic regression models for predicting use and non-use, and for predicting private versus public sector use, were constructed using the Andersen Behavioural Model as the conceptual framework. Our findings indicate that sex, location and possession index quartile are factors that influence the decision to seek care or not for respiratory illness in under-fives. In contrast, the choice between the public and private sector is determined by location and insurance status. From the policy perspective, if the Dominican Republic were to undertake steps to increase private insurance coverage, our results indicate that this would lead to increased utilization of private sector providers for respiratory illness by children having private insurance, but would not have an impact on overall utilization (i.e. use vs. non-use). On the other hand, one of the ways to deliver cost-effective interventions by the publicly financed system would be to improve facilities in the rural areas.