Associations of Generalized Trust and Social Participation at the Individual Level with Unmet Healthcare Needs in Communities with High Mortality

Influencing Factors of Transportation Costs Regarding Healthcare Service Utilization in Korea

BACKGROUND

Transportation costs can be a barrier to healthcare services, especially for low-income, disabled, elderly, and geographically isolated populations. This study aimed to estimate the transportation costs of healthcare service utilization and related influencing factors in Korea in 2016.

METHODS

Transportation costs were calculated using data from the 2016 Korea Health Panel Study. A total of 14,845 participants were included (males, 45.07%; females, 54.93%), among which 2,148 participants used inpatient and 14,787 used outpatient care services. Transportation costs were estimated by healthcare types, transportation modes, and all disease and injury groups that caused healthcare service utilization. The influencing factors of higher transportation costs were analyzed using multivariable regression analysis.

RESULTS

In 2016, the average transportation costs were United States dollars (USD) 43.70 (purchasing power parity [PPP], USD 32.35) per year and USD 27.67 (PPP, USD 20.48) per visit for inpatient care; for outpatient case, costs were USD 41.43 (PPP, USD 30.67) per year and USD 2.09 (PPP, USD 1.55) per visit. Among disease and injury groups, those with neoplasms incurred the highest transportation costs of USD 9.73 (PPP, USD 7.20). Both inpatient and outpatient annual transportation costs were higher among severely disabled individuals (inpatient, +USD 44.71; outpatient, +USD 23.73) and rural residents (inpatient, +USD 20.40; outpatient, +USD 28.66). Transportation costs per healthcare visit were influenced by healthcare coverage and residential area. Sex, age, and income were influencing factors of higher transportation costs for outpatient care.

CONCLUSION

Transportation cost burden was especially high among those with major non-communicable diseases (e.g., cancer) or living in rural areas, as well as elderly, severely disabled, and low-income populations. Thus, there is a need to address the socioeconomic disparities related to healthcare transportation costs in Korea by implementing targeted interventions in populations with restricted access to healthcare.

Relationship between social capital and heroin use behaviors among patients in methadone maintenance treatment in Sichuan Province, China: A cross-sectional study

Covertly using heroin during methadone maintenance treatment (MMT) is very common among heroin-dependent patients, which has posed threats to the physical health of heroin-dependent patients and social safety. Covertly using heroin may be influenced by many factors, especially social capital. Therefore, we aimed to investigate the relationship between behaviors of covertly using heroin during MMT and social capital heroin-dependent patients in Sichuan Province, China. A cross-sectional study was conducted between October and November 2018, with a total of 581 heroin-dependent patients participating in the study. In addition to socio-demographic characteristics and heroin use related behaviors, the questionnaire also included the measures of social capital: social network (SN), social support (SP), community participation (CP) and social trust (ST). Multivariate logistic regression analyses were used to estimate the association between different measures of social capital and heroin use. The prevalence of covertly using heroin of heroin during MMT was 31.0% among our participants in the 6 months before the study. After adjusting for socio-demographic factors and heroin-use related variables, SN (OR = 0.85, 95% CI: 0.76-0.95), SP (OR = 0.89, 95% CI: 0.83-0.95), and ST (OR = 0.88, 95% CI: 0.81-0.95) were significantly associated with heroin use. Results suggest that social capital may have a protective effect on behavior of covertly using heroin during MMT, which should be consider in the interventions for heroin-dependent patients, in order to reduce the incidence of heroin use during MMT as well as improve the compliance of MMT.

Why not see a doctor when ill? Evidence from the Chinese elderly

BACKGROUND

Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as "not see a doctor". This study aimed to describe the reason distribution of"not see a doctor" among the Chinese elderly. Specifically,we examined the reasons why"not see a doctor" happened to the Chinese elderly with different characteristics.

METHODS

In order to explore the associations between various predisposing, enabling and need factors and "not see a doctor" in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between "not see a doctor" and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for "not see a doctor").

RESULTS

Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported "not see a doctor". Overall, those with older age, other marital status (except married) and poorer health status were more likely to report "not see a doctor". No significant associations were found between income and "not see a doctor". The majority of cases report "no need" as the reason for their "not see a doctor". Except reason "no need", factor associated with the healthcare system-cost-accounted for the most case of "not see a doctor". Those without health insurance are more likely not to see a doctor due to affordability issues.

CONCLUSIONS

This quantitative study suggests that "not see a doctor" is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.