Prevalence and frequency of health service use: associations with occupational prestige and educational attainment

Black Americans' Diminished Health Returns of Professional Occupations: A Thirty-Year Follow-Up Study of Middle-Aged and Older Adults

INTRODUCTION

Occupational classes exert substantial effects on both subjective and objective health outcomes. However, it remains unclear whether the health impact of similar occupational classes varies across racial groups among middle-aged and older adults in the United States.

AIM

Grounded in the theory of Minorities' Diminished Returns (MDRs), which posits that health benefits from resources such as employment are systematically weaker for racial minority populations, particularly Non-Latino Black individuals, this study tested Black-White disparities in the effects of similar occupational classes on health outcomes in middle-aged and older adults.

METHODS

Utilizing data from the Health and Retirement Study (HRS), we employed a 30-year longitudinal design with a nationally representative sample of middle-aged and older adults in the United States. Six occupational classes-operator, managerial, professional specialty, sales, clerical/admin, and service-served as the key predictor variables (independent variables), with race as the moderator. Various health outcomes, including self-rated health, chronic disease, body mass index (BMI), activities of daily living (ADL), and cognitive function, were measured longitudinally from wave 1 to wave 15 (from baseline to 30 years later). Statistical analyses, incorporating logistic regression models, were conducted to assess associations between occupational class and health outcomes overall and based on race.

RESULTS

Our analysis included 7538 Non-Latino White or Non-Latino Black participants followed for up to 30 years. Initial findings revealed positive health effects of professional occupations on cognitive function and self-rated health over 30 years of follow-uWe also identified significant interactions between race and professional occupational class on all health outcomes, indicating notable racial differences in the effects of professional occupations on health outcomes across domains. The effects of professional occupational class were weaker for Non-Latino Black individuals than for Non-Latino White individuals.

CONCLUSION

Consistent with the Minorities' Diminished Returns theory, our findings indicated less pronounced positive effects of professional occupations on a wide range of health outcomes for Non-Latino Black individuals compared to Non-Latino Whites. These disparities emphasize the critical need to address structural factors that contribute to the diminished returns of prestigious occupations for Non-Latino Black populations.

A local study of costs for private allied health in Australian primary health care: variability and policy implications

Multidisciplinary approaches to primary health care improve outcomes for individuals living with chronic conditions. However, emerging evidence suggests access to allied health professionals in Australia is problematic. This paper reports findings of a telephone survey of allied health professionals’ billing practices in one urban area. The survey was undertaken as a quality improvement project in response to the affordability queries raised by patients and carers in the clinical setting. The aim was to determine financial cost of access to allied health professionals in one urban primary health care setting. Participant practices included: physiotherapy (n = 21), podiatry (n = 8) and dietitians (n = 3). Fees were variable, with cost of the initial (assessment) appointment higher than subsequent (follow-up) appointments in 92% of practices. The average out of pocket expenses for assessment and three follow-up appointments ranged from $258 to $302. When available, the Medicare rebate reduced this to $58–106. Bulk billing was not offered. Variable costs, minimal concessions and absence of bulk billing in this confined geographical area creates a cost barrier to access for patients from lower socioeconomic groups and has implications for access to multidisciplinary care in Australian primary health care.

Factors Associated with Medicine Use and Non-use by Ontario Seniors

While there is growing evidence of the increasing use of medicines by the elderly, research undertaken to critically examine differences among types of medicine users in this population is limited. Using population data, we examine the influence of social, demographic, and health-related factors on likelihood of being a non-user, a user of non-prescribed medicines only, or a user of prescription medicines only. We find some evidence of the rational use of drugs (i.e., those who are in better health are more likely to be non-users or to use non-prescribed medicines than those who are in poor health) and of rational explanations for reported use (i.e., being female is associated with less likelihood of non-use or exclusive use of non-prescription medicines than being male). Further analysis of the medicine-use patterns and decisions of elderly men and of those of elderly persons who are widowed or separated/divorced is warranted.

The use of end-quintile comparisons to identify under-servicing of the poor and over-servicing of the rich: a longitudinal study describing the effect of socioeconomic status on healthcare

BACKGROUND

To demonstrate the use of end-quintile comparisons in assessing the effect of socio-economic status on hospital utilisation and outcomes in Western Australia.

METHODS

Hospital morbidity records were extracted from the WA Data Linkage System for the period 1994-99, with follow-up to the end of 2000. Multivariate modelling was used to estimate the effect of socio-economic status on hospital admission rates, average and total length of stay (LOS), cumulative incidence of readmission at 30 days and one year, and case fatality at one year.

RESULTS

The study demonstrated higher rate ratios of hospital admission in the more disadvantaged quintiles: rate ratios were 1.31 (95% CI 1.25-1.37) and 1.32 (1.26-1.38) in the first quintile (most disadvantaged) and the second quintile respectively, compared with the fifth quintile (most advantaged). There was a longer total LOS in the most disadvantaged quintile compared with quintile 5 (LOS ratio 1.24; 1.23-1.26). The risk of readmission at 30 days and one year and the risk of death at one year were also greater in those with greater disadvantage: the hazard ratios for quintiles 1:quintile 5 were 1.07 (1.05-1.09), 1.17 (1.16-1.18) and 1.10 (1.07-1.13) respectively. In contradiction to the trends towards higher hospital utilisation and poorer outcomes with increasing social disadvantage, in some MDC's the rate ratio of quintile 1:quintile 2 was less than 1, and quintile 4:quintile 5 was greater than 1. For all surgical admissions the most disadvantaged had a significantly lower admission rate than the second quintile.

CONCLUSION

This study has shown that the disadvantaged within Western Australia are more intensive users of hospital services but their outcomes following hospitalisation are worse, consistent with their health status. Instances of overuse in the least disadvantaged and under use in the most disadvantaged have also been identified.

Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?

BACKGROUND

Despite enormous public sector expenditures, the effectiveness of universal coverage for health care in reducing socioeconomic disparities in health has received little attention.

STUDY OBJECTIVE

s: To evaluate whether universal coverage for health care reduces socioeconomic disparities in health.

DESIGN

Information on participants of the 1990 Nova Scotia Nutrition Survey was linked with eight years of administrative health services data and mortality. The authors first examined whether lower socioeconomic groups use more health services, as would be expected given their poorer health status. They then investigated to what extent differential use of health services modifies socioeconomic disparities in mortality. Finally, the authors evaluated health services use in the last years of life when health is poor regardless of a person's socioeconomic background.

SETTING

The Canadian province of Nova Scotia, which provides universal health care coverage to all residents.

PARTICIPANTS

1816 non-institutionalised adults, aged 18-75 years, from a two stage cluster sample stratified by age, gender, and region.

MAIN RESULTS

People with lower socioeconomic background used comparatively more family physician and hospital services, in such a way as to ameliorate the socioeconomic differences in mortality. In contrast, specialist services were comparatively underused by people in lower socioeconomic groups. In the last three years of life, use of specialist services was significantly higher in the highest income group.

CONCLUSIONS

Universal coverage of family physician and hospital services ameliorate the socioeconomic differences in mortality. However, specialist services are underused in lower socioeconomic groups, bearing the potential to widen the socioeconomic gap in health.

Access and equity in the provision of general practitioner services for women in Australia

OBJECTIVE

To assess geographical equity in the availability, accessibility and out-of-pocket costs of general practitioner (GP) services for women in Australia.

METHOD

Data on general practice consultations during 1995 and 1996 for women aged 18-23 years (n = 5,260), 45-50 years (n = 7,898) and 70-75 years (n = 6,542) in the Australian Longitudinal Study on Women's Health were obtained from the Health Insurance Commission. A sub-study of 4,577 participants provided data on access to health services.

RESULTS

Older women were more likely to have no out-of-pocket costs for their GP consultations, but in all age groups, the proportion was lower in rural areas than in urban areas (older age: 60% rural areas, 76% capital cities; mid-age: 24% rural areas, 40% capital cities; young age: 35% rural areas, 52% capital cities). Among mid-aged women, the median out-of-pocket cost per consultation ranged from $2.11 in capital cities to $6.48 in remote areas. Women living in rural and remote areas gave lower ratings for the availability, accessibility and affordability of health services than women living in urban areas.

CONCLUSIONS

This study has shown a striking gradient in financial and nonfinancial barriers to health care associated with area of residence.

IMPLICATIONS

The geographical imbalance in the supply and distribution of GP services in Australia has long been recognised but inequities in the affordability of services must also be addressed. Longitudinal survey data and Health Insurance Commission data provide a means to evaluate policies designed to improve access to health services in rural and remote areas.