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Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
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Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Mackie AS, Bravo-Jaimes K, Keir M, Sillman C, Kovacs AH. Access to Specialized Care Across the Lifespan in Tetralogy of Fallot. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:267-282. [PMID: 38161668 PMCID: PMC10755796 DOI: 10.1016/j.cjcpc.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 01/03/2024]
Abstract
Individuals living with tetralogy of Fallot require lifelong specialized congenital heart disease care to monitor for and manage potential late complications. However, access to cardiology care remains a challenge for many patients, as does access to mental health services, dental care, obstetrical care, and other specialties required by this population. Inequities in health care access were highlighted by the COVID-19 pandemic and continue to exist. Paradoxically, many social factors influence an individual's need for care, yet inadvertently restrict access to it. These include sex and gender, being a member of a racial or ethnic historically excluded group, lower educational attainment, lower socioeconomic status, living remotely from tertiary care centres, transportation difficulties, inadequate health insurance, occupational instability, and prior experiences with discrimination in the health care setting. These factors may coexist and have compounding effects. In addition, many patients believe that they are cured and unaware of the need for specialized follow-up. For these reasons, lapses in care are common, particularly around the time of transfer from paediatric to adult care. The lack of trained health care professionals for adults with congenital heart disease presents an additional barrier, even in higher income countries. This review summarizes challenges regarding access to multiple domains of specialized care for individuals with tetralogy of Fallot, with a focus on the impact of social determinants of health. Specific recommendations to improve access to care within Canadian and American systems are offered.
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Affiliation(s)
- Andrew S. Mackie
- Division of Cardiology, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michelle Keir
- Southern Alberta Adult Congenital Heart Clinic, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christina Sillman
- Adult Congenital Heart Disease Program, Sutter Heart and Vascular Institute, Sacramento, California, USA
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Kocot E. Unmet Health Care Needs of the Older Population in European Countries Based on Indicators Available in the Eurostat Database. Healthcare (Basel) 2023; 11:2692. [PMID: 37830729 PMCID: PMC10572618 DOI: 10.3390/healthcare11192692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
Access to healthcare may affect the health of the population, especially older people. The aim of this study is to analyze the reasons and factors influencing the unmet healthcare needs (UHCN) of the older population in the context of differences between age groups for 28 European countries. A self-reported UHCN indicator obtained from Eurostat database was used. The share of people with healthcare needs reporting distance/transportation issues was significantly different in the younger and older groups, as well as in age groups within the older population. The differences in other reasons were not so considerable. Problems with UHCN were observed more often in the older population with lower rather than with higher income and with more severe activity limitations rather than with none/moderate limitations (differences statistically significant, except for income for 75+). In most countries, the UHCN dependence on income/activity limitation is higher in the age group of 15-64 than for the older population. To plan/introduce/monitor appropriate, tailored actions for improving healthcare access for the older population, a detailed analysis of the UHCN prevalence, reasons, and determinants in this age group is needed; it is insufficient to analyze only the population as a whole. Additionally, the group of older people is not homogeneous in terms of UHCN.
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Affiliation(s)
- Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawinska 8, 31-066 Krakow, Poland
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Lavergne MR, Bodner A, Allin S, Christian E, Hajizadeh M, Hedden L, Katz A, Kephart G, Leslie M, Rudoler D, Spencer S. Disparities in access to primary care are growing wider in Canada. Healthc Manage Forum 2023; 36:272-279. [PMID: 37340726 PMCID: PMC10447912 DOI: 10.1177/08404704231183599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Canadian provinces and territories have undertaken varied reforms to how primary care is funded, organized, and delivered, but equity impacts of reforms are unclear. We explore disparities in access to primary care by income, educational attainment, dwelling ownership, immigration, racialization, place of residence (metropolitan/non-metropolitan), and sex/gender, and how these have changed over time, using data from the Canadian Community Health Survey (2007/08 and 2015/16 or 2017/18). We observe disparities by income, educational attainment, dwelling ownership, recent immigration, immigration (regular place of care), racialization (regular place of care), and sex/gender. Disparities are persistent over time or increasing in the case of income and racialization (regular medical provider and consulted with a medical professional). Primary care policy decisions that do not explicitly consider existing inequities may continue to entrench them. Careful study of equity impacts of ongoing policy reforms is needed.
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Affiliation(s)
| | | | - Sara Allin
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alan Katz
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Sarah Spencer
- Simon Fraser University, Burnaby, British Columbia, Canada
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Khattar J, Anderson LN, De Rubeis V, de Groh M, Jiang Y, Jones A, Basta NE, Kirkland S, Wolfson C, Griffith LE, Raina P. Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging. CMAJ Open 2023; 11:E140-E151. [PMID: 36787988 PMCID: PMC9933993 DOI: 10.9778/cmajo.20210320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected access to health care services in Canada; however, limited research examines the influence of the social determinants of health on unmet health care needs during the first year of the pandemic. The objectives of this study were to describe unmet health care needs during the first year of the pandemic and to investigate the association of unmet needs with the social determinants of health. METHODS We conducted a prospective cohort study of 23 972 adults participating in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study (April-December 2020) to identify the social determinants of health associated with unmet health care needs during the pandemic. Using logistic regression, we assessed the association between several social determinants of health on the following 3 outcomes (separately): experiencing any challenges in accessing health care services, not going to a hospital or seeing a doctor when needed, and experiencing barriers to accessing testing for SARS-CoV-2 infection. RESULTS From September to December 2020, 25% of participants experienced challenges accessing health care services, 8% did not go to a hospital or see a doctor when needed and 4% faced barriers accessing testing for SARS-CoV-2 infection. The prevalence of all 3 unmet need outcomes was lower among older age groups. Differences were observed by sex, region, education, income and racial background. Immigrants (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.09-1.27) or people with chronic conditions (OR 1.35, 95% CI 1.27-1.43) had higher odds of experiencing challenges accessing health care services and had higher odds of not going to a hospital or seeing a doctor (immigrants OR 1.26, 95% CI 1.11-1.43; chronic conditions OR 1.45, 95% CI 1.31-1.61). Prepandemic unmet health care needs were strongly associated with all 3 outcomes. INTERPRETATION Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity.
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Affiliation(s)
- Jayati Khattar
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Margaret de Groh
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Ying Jiang
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Nicole E Basta
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Susan Kirkland
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Christina Wolfson
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Smolić Š, Čipin I, Međimurec P. Access to healthcare for people aged 50+ in Europe during the COVID-19 outbreak. Eur J Ageing 2022; 19:793-809. [PMID: 36692730 PMCID: PMC8195455 DOI: 10.1007/s10433-021-00631-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 01/26/2023] Open
Abstract
This paper combines SHARE Corona Survey and SHARE Wave 7 data for 25 European countries and Israel (N = 40,919) with institutional and epidemic-related country characteristics to investigate healthcare access for Europeans aged 50+ during the outbreak of COVID-19. We use a micro-macro approach to examine whether and to what extent barriers to accessing healthcare measured by reported unmet healthcare needs vary within and between countries. We consider various aspects of barriers and distinguish among: (1) respondents who forewent medical treatment because they were afraid of becoming infected with the Coronavirus; (2) respondents who had pre-scheduled medical appointments postponed by health providers due to the outbreak; and (3) respondents who tried to arrange a medical appointment but were denied one. Limited access to healthcare during the initial outbreak was more common for the occupationally active, women, the more educated and those living in urban areas. A bad economic situation, poor overall health and higher healthcare utilisation were robust predictors of unmet healthcare. People aged 50+ in countries of 'Old' Europe, countries with higher universal health coverage and stricter containment and closure policies were more likely to have medical services postponed. Policymakers should address the healthcare needs of older people with chronic health conditions and a poor socio-economic status who were made more vulnerable by this pandemic. In the aftermath of the health crisis, public health systems might experience a great revival in healthcare demand, a challenge that should be mitigated by careful planning and provision of healthcare services.
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Affiliation(s)
- Šime Smolić
- Faculty of Economics & Business, Department of Macroeconomics and Economic Development, University of Zagreb, Zagreb, Croatia
| | - Ivan Čipin
- Faculty of Economics & Business, Department of Demography, University of Zagreb, Zagreb, Croatia
| | - Petra Međimurec
- Faculty of Economics & Business, Department of Demography, University of Zagreb, Zagreb, Croatia
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7
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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8
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Schmidt AE, Rodrigues R, Simmons C, Steiber N. A crisis like no other? Unmet needs in healthcare during the first wave of the COVID-19 crisis in Austria. Eur J Public Health 2022; 32:969-975. [PMID: 36219785 PMCID: PMC9619656 DOI: 10.1093/eurpub/ckac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Many patients experienced restricted access to healthcare during the Coronavirus Disease 2019 (COVID-19) pandemic. This study is among the first to provide systematic evidence on the existence of subjective unmet needs (SUN) in different population groups during the pandemic. Methods Using data on individuals aged 20–64 and living in Austria from the AKCOVID survey (June 2020) and the ‘European Social Survey’ (2015), SUN were compared between 2015 and 2020, either related to the pandemic (fear of infection, provider closed or treatment postponed) or not (barriers related to knowledge, affordability, time and reachability). Multinomial logistic regression models identified determinants of SUN during the pandemic, adjusting for socio-demographics, socio-economic status and self-reported health. Results Shares of the population with SUN in 2020 substantially exceeded SUN in 2015. Excess unmet needs were mostly attributable to the pandemic. Postponed treatments and closed providers were the most important reasons for SUN in June 2020. Older age groups (50–64 years), inactive and retired people were most likely to report pandemic-related SUN. We did not find socio-economic differences in pandemic-related SUN. Conclusions The pandemic resulted in a supply-side shock to healthcare, with vulnerabilities emerging especially among older people, people with poor health and/or people no longer active on the labour market. Further research could focus on health system resilience and the possibilities to improve management of healthcare services during pandemics without widening inequalities while maintaining population health.
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Affiliation(s)
- Andrea E Schmidt
- Austrian National Public Health Institute, Competence Centre on Climate and Health, Vienna, Austria
| | - Ricardo Rodrigues
- ISEG Lisbon School of Economics and Management, University of Lisbon, Lisbon, Portugal
| | - Cassandra Simmons
- Health and Care, European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Nadia Steiber
- Department of Sociology, University of Vienna, Vienna, Austria.,Institute for Advanced Studies, Vienna, Austria
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Vigezzi GP, Bertuccio P, Amerio A, Bosetti C, Gori D, Cavalieri d’Oro L, Iacoviello L, Stuckler D, Zucchi A, Gallus S, Odone A, Investigators LILP. Older Adults' Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811271. [PMID: 36141544 PMCID: PMC9565221 DOI: 10.3390/ijerph191811271] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults' changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient's decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05-1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00-1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run.
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Affiliation(s)
- Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Collegio Ca’ della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
| | - Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16124 Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy
| | - Cristina Bosetti
- Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Science, University of Bologna, 40126 Bologna, Italy
| | | | - Licia Iacoviello
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy
| | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
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10
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Chung W. Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data. Front Public Health 2022; 10:828318. [PMID: 35372247 PMCID: PMC8971121 DOI: 10.3389/fpubh.2022.828318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
While many studies have explored the financial barriers to healthcare, there is little evidence regarding the non-financial barriers to healthcare. This study identified characteristics associated with financial and non-financial barriers to healthcare and quantified the effects of these characteristics in South Korea, using a nationally representative longitudinal survey dataset. Overall, 68,930 observations of 16,535 individuals aged 19 years and above were sampled from Korea Health Panel survey data (2014-2018). From self-reported information about respondents' experiences of unmet healthcare needs, a trichotomous dependent variable-no barrier, non-financial barrier, and financial barrier-was derived. Sociodemographics, physical and health conditions were included as explanatory variables. The average adjusted probability (AAP) of experiencing each barrier was predicted using multivariable and panel multinomial logistic regression analyses. According to the results, the percentage of people experiencing non-financial barriers was much higher than that of people experiencing financial barriers in 2018 (9.6 vs. 2.5%). Women showed higher AAPs of experiencing both non-financial (9.9 vs. 8.3%) and financial barriers (3.6 vs. 2.5%) than men. Men living in the Seoul metropolitan area showed higher AAPs of experiencing non-financial (8.7 vs. 8.0%) and financial barriers (3.4 vs. 2.1%) than those living outside it. Household income showed no significant associations in the AAP of experiencing a non-financial barrier. People with a functional limitation exhibited a higher AAP of experiencing a non-financial barrier, for both men (17.8 vs. 7.8%) and women (17.4 vs. 9.0%), than those without it. In conclusion, people in South Korea, like those in most European countries, fail to meet their healthcare needs more often due to non-financial barriers than financial barriers. In addition, the characteristics associated with non-financial barriers to healthcare differed from those associated with financial barriers. This finding suggests that although financial barriers may be minimised through various policies, a considerable degree of unmet healthcare needs and disparity among individuals is very likely to persist due to non-financial barriers. Therefore, current universal health insurance systems need targeted policy instruments to minimise non-financial barriers to healthcare to ensure effective universal health coverage.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
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