河南省60岁以上老年人卫生服务需求与利用分析

目的 了解河南省老年人卫生服务需求与利用情况及其影响因素。方法 利用第六次国家卫生服务调查数据中河南省老年人的数据,分析其卫生服务需求和利用情况。统计分析采用χ2检验和logistic回归。结果 河南省老年人的两周患病率为49.89%,慢性病患病率为57.06%,两周就诊率为22.80%;70岁、文化水平低和自评健康状况差是老年人两周患病的危险因素;城市人群、家庭人均年收入低、高血压、糖尿病和自评健康状况差为老年人两周就诊的危险因素。结论 河南省老年人卫生服务需求较高。老年人卫生服务工作应以贫困老年人为重点,充分发挥基层医疗机构的作用,发展针对贫困人群医疗救助制度,以此提升河南省老年人的卫生服务利用率。     

流动老年人健康状况及医疗服务利用影响因素分析

目的:了解我国流动老年人健康状况及医疗服务利用现状,分析流动老年人医疗服务利用的影响因素,为提高流动老年人健康状况提供建议。方法:使用"2015年全国流动人口卫生计生动态监测调查"数据,以Anderson模型为理论框架,使用两分类Logistic回归模型对医疗服务利用影响因素进行实证分析。结果:5 164名流动老年人中,健康或基本健康、患有医生确诊的高血压或糖尿病的流动老年人比例分别为88.57%、16.00%;年龄、家庭收入、本地朋友数量及是否患有慢性病对平时生小病是否就医有影响(P0.05);年龄、基本医疗保险、本地朋友数量、自评健康状况及是否患有慢性病对住院服务利用有显著影响(P0.05)。建议:"三保合一"有望改善流动老年人医疗保险保障作用;加强流动老年人家庭及社会支持建设;做好预防医疗服务具有较好成本效益;关注流动老年人医疗服务利用公平性。     

Social inequality in health and the utilization of health services among the elderly in Latin America]

OBJECTIVE: To learn if there is social inequality in health and in the utilization of health services among the elderly in six cities of Latin America: Buenos Aires, Argentina; S?o Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. METHODS: This study used data from a project called Health, Well-being, and Aging in Latin America and the Caribbean (known as the "SABE project"). To investigate the presence of social inequality in health an ordinal probit model was used, with health status indicated by the following dependent variables: activities of daily living, instrumental activities of daily living, physical mobility, and self-rated health. To measure social inequality in the utilization of health services two characteristics were assessed: one for outpatient medical services (whether or not individuals received outpatient care, and how many times), and one for hospital admissions (whether or not individuals were hospitalized). For outpatient services, we estimated a negative binomial hurdle model, and for hospital admissions, a logit model was constructed. RESULTS: Our main results suggest the presence of social inequality in health in all the cities, with better-off socioeconomic groups having better health. The difference in health was less marked in Havana, Buenos Aires, and Montevideo, and it was more pronounced in S?o Paulo and Mexico City. With respect to the utilization of health services we found inequalities in the use of outpatient services in Santiago, Mexico City, and S?o Paulo. In Santiago and Mexico City, more schooling was associated with a higher number of expected outpatient medical visits; however, the opposite was found in S?o Paulo. For hospital admissions, inequality was found only in S?o Paulo, with individuals with more years of schooling being much more likely to be hospitalized. CONCLUSION: To a certain extent, our results reflect the socioeconomic and demographic characteristics of the countries in which each of the six cities is located. The cities in the countries with the worst social indicators (high income inequality and low human development index) tended to have the greatest inequalities in health and in the utilization of health services.     

中国老年残疾人口康复服务利用现状及影响因素分析

目的：探索中国老年残疾人口康复服务利用现状及其影响因素。方法：使用第二次全国残疾人抽样调查数据。应用卡方检验分析老年群体间康复服务利用差异。应用多因素logistic回归模型分析老年残疾人口康复服务利用的影响因素。结果：老年残疾人口康复服务利用率(45.82%)远低于需求率(96.89%),各项康复服务均存在较大需求与利用缺口。罹患听力残疾、中轻度残疾(三、四级)、高龄(≥80)、离婚或丧偶对老年残疾人口利用康复服务有抑制作用;残疾类型为肢体残疾或精神残疾、男性、未婚、居住在城镇、有残疾人证、有社会保险、较高的受教育水平和户人均年收入对其服务利用有促进作用。不同因素在城乡间作用方向一致,作用程度存在差异。结论：中国老年残疾人口康复服务需求尚未得到较好满足。基本人口特征、家庭特征、社会环境支持、残疾状态均影响其康复服务利用。应落实残疾报告制度;统筹康复服务资源配置;开展老年群体的健康评估与跟踪;加快完善康复服务项目的医疗保障范畴,建立以功能恢复为导向的支付原则。     

Insurance, acculturation, and health service utilization among Korean-Americans

This study describes the pattern and predictors of ambulatory care utilization among Korean Americans (KAs) living in Los Angeles. Data were gathered via a mail survey. Analysis employed a two-part model: logit model for factors affecting any health care use and truncated negative binomial model for frequency of use given one visit. Use of ambulatory care among KAs was low (2.80 visits during prior 12 months), compared to their counterparts in South Korea and the U.S. population. Variables associated with higher utilization included old age, health needs, and health insurance. Income had a positive effect on health care utilization decisions among the uninsured. Acculturation appeared to be neither a strong nor consistent predictor of ambulatory care utilization among KAs. Of particular concern is the finding that KAs suffer from inadequate access to care due to lack of employment-based health insurance.     

老年人群医疗服务利用公平性影响因素研究

目的:分析中国老年人医疗服务利用的公平性问题及其影响因素。方法:利用CHARLS 2013年全国调查数据,选取60岁及以上人群作为研究对象。通过集中指数和集中曲线分析老年人医疗服务利用是否存在不公平问题;通过集中指数分解法分析老年人医疗服务利用不公平的主要影响因素。结果:老年人门诊和住院服务利用的集中指数分别为0.0619和0.1050,集中曲线均位于绝对公平线的下方。通过集中指数分解法发现,对门诊服务利用集中指数贡献为正向且贡献率较大的因素为:家庭年人均消费性支出、退休金金额;贡献为负向且贡献率较大的因素为:新型农村合作医疗保险,躯体性日常生活能力PADL。对住院服务集中指数贡献为正向且贡献率较大的因素为:家庭年人均消费性支出、城镇职工基本医疗保险,贡献为负向且贡献率较大的因素为:新型农村合作医疗保险、躯体性日常生活能力PADL。门诊和住院服务利用水平的不公平指数(HI)分别为0.0739和0.1339,说明老年人门诊和住院服务利用存在不公平。结论:老年人医疗服务利用存在不公平问题,经济水平是不公平的第一位贡献因素,需要类因素、新型农村合作医疗保险可缩小不公平差距。     

宁夏农村老年人卫生服务需求与利用现状

目的 了解宁夏农村≥60岁老年人卫生服务需求及利用现状,为卫生决策提供依据。方法 2015年3月,采用多阶段分层随机抽样方法,在宁夏随机抽取的5个县中对随访到的3 817名≥60岁老年人进行卫生服务需求及利用情况调查。结果 宁夏农村≥60岁老年人自报两周患病率为25.1%,慢性病患病率为48.9%;两周就诊率为11.0%,两周患病未就诊率为56.2%;调查前一年内老年人住院率为24.9%,患病未住院率为5.1%;慢性病就诊率为32.0%;老年人两周患病就诊、住院的首选医疗机构、慢性病患病主要就诊机构均为县级医院;两周患病未就诊原因主要为自感病轻和经济困难,近一年内患病未住院原因主要为经济困难。结论 宁夏农村≥60岁老年人的健康状况仍不容乐观,农村老年人的卫生服务需求和利用依然具有很大的提升空间。     

老年居民对社区卫生服务利用及满意度调查

目的 了解山西省太原市老年居民对社区卫生服务利用及满意情况,为开展社区卫生服务工作提供依据.方法 采用整群随机抽样方法对太原市4个社区卫生服务站257名65岁以上就诊老年居民进行面对面询问调查.采用SPSS 11.5统计软件描述频数分布,利用累加Logistic回归模型进行因素分析.结果 到社区卫生服务站就诊者中,老年女性、低文化程度、低家庭收入占多数,首选社区卫生服务机构就诊者中医疗费用负担方式以自费占绝大多数(71.8%).就诊目的以开药(80.2%)、诊疗(32.7%)、输液(32.7%)为主,就诊原因主要是快捷方便(60.0%)、离家近(45.9%)、解决小病(17.9%)、态度好(16.7%)等,对社区卫生服务机构总体满意度为46.3%.累加Logistic回归分析结果显示:影响老年人医疗服务满意度因素为性别、文化程度、经济收入、医疗费用负担方式、首诊地点选择.结论 社区老年居民对健康保健服务需求较高,对社区卫生服务较为满意认可,医疗服务质量有待进一步提高.     

Mental health service utilization among the Arabs in Israel

National hospitalization records (1995, 1986, N = 15,698) reveal that Arab women utilize psychiatric services less than Arab men. The exact reverse occurs among Jewish patients. Moreover, Arab patients significantly underutilize mental health services, compared to Jewish patients. Possible reasons for these utilization patterns include: Arab health care utilization patterns in general; the availability of mental health services in Arab communities; the influence of the "cultural" over the "professional" in Arab mental health utilization; the lack of Arab mental health practitioners; Arab attitudes towards mental health; and gendered role constructions within Arab society. Findings emphasize the need for a policy of developing infrastructure and trained personnel that can provide services adapted to the special cultural characteristics of the Arab population.     

Religion and preventative health care utilization among the elderly

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.     

Distance and health care utilization among the rural elderly

This paper explores the relationship between distance and the utilization of health care by a group of elderly residents in rural Vermont. By drawing on recent work on the geography of health we frame the decision to visit a primary care physician in the context of the experience of place. The paper devises a test of this broader reading of the role of distance for utilization, and operationalizes this test using a custom designed survey. Using a randomized mail survey of elderly residents of Vermont's North East Kingdom we explore how grocery shopping, travel to work, home location relative to local services, access to private transportation, and living arrangements are associated with the number of doctor visits made to primary health care providers. Although the results confirm the idea that increased distance from provider does reduce utilization, they strongly suggest that distance to provider is a surrogate for location in a richer web of relations between residents and their local communities. We conclude by calling for further research that establishes links between place and the use of health facilities.     

Depression, service utilization, and treatment costs among Medicare elderly: gender differences.

OBJECTIVE: To compare gender differences in mood disorders, service utilization, and health care costs among a random sample of Medicare elderly beneficiaries of Tennessee. DATA SOURCES: Medicare expenditure data from a 5% random sample of Tennessee Medicare beneficiaries (n = 35,673) were examined for 1991-1993. The physician reimbursement files provided data relative to ICD-9 diagnostic codes, physician visits, and the cost of physician services provided. Other service utilization and cost data were obtained for the sample from the outpatient, home health, skilled nursing, hospice and inpatient files. STUDY DESIGN: The dependent variables were: (i) patients with ICD-9 diagnosis for a mood disorder (major depression and other depression), (ii) service utilization (number of outpatient visits, skilled nursing visits, home health visits, physician visits, emergency visits, and inpatient days), and (iii) health care costs (dollar amount of physician cost, outpatient cost, inpatient cost, total mental health cost, total health cost, and other cost). The independent variable was gender. PRINCIPLE FINDINGS: Chi-square tests showed that among the patients with a mood disorder, females had a significantly higher incidence than males of major depression (1.3% vs. .4%, respectively, p < .001) and other depression (1.6% vs. .6%, respectively, p < .001). Further, t-test results indicated that females diagnosed with major depression utilized significantly more outpatient services than males (3.2 vs. 2.6, respectively, p < .04). Total health care costs for those with other depression were significantly higher for males than females ($15,060 vs. $10,240, respectively, p < .002). CONCLUSIONS: The results indicate that mood disorders, outpatient services, and total mental health costs are higher for females than males; however, total health care costs are higher for males than females.     

Effects of health literacy on health status and health service utilization amongst the elderly

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. With a sample of 489 elderly Medicare patients in a Midwestern city in the USA, we explored the intermediate factors that may link health literacy to health status and utilization of health services such as hospitalization and emergency care. We expected to find that individuals with higher health literacy would have better health status and less frequent use of emergency room and hospital services due to (1) greater disease knowledge, (2) healthier behaviors, (3) greater use of preventive care, and (4) a higher degree of compliance with medication. Using path analysis, we found, however, that health literacy had direct effects on health outcomes and that none of these variables of interest was a significant intermediate factor through which health literacy affected use of hospital services. Our findings suggest that improving health literacy may be an effective strategy to improve health status and to reduce the use of expensive hospital and emergency room services among elderly patients.     

老年出院病人健康状况及后续卫生服务利用的研究

本研究基于三城市老年出院病人后续卫生服务的需求和利用情况,描述了老年出院病人的自我健康感觉、遵从医嘱,以及对不同卫生服务机构的利用情况,为完善后续卫生服务模式、促进社区卫生服务机构与医院资源和服务的互动整合提出相关政策建议。     

"空巢"对上海市老年人健康与卫生服务利用公平性的影响

目的:了解"空巢"对老年人健康与卫生服务利用的影响.方法:采用问卷调查方法,对"空巢"和非"空巢"老人的健康和卫生服务利用进行调查.结果:与非"空巢"老人相比,"空巢"老人的两周患病率和慢性病患病率较高;两组人群两周就诊率和年住院率的差异没有统计学意义.结论:与非"空巢"老人相比,"空巢"老人存在健康与卫生服务利用的相对不公平性.     

照料孙辈对我国农村中老年人心理健康的影响

本文使用中国健康与养老追踪调查的面板数据，分析了照料孙辈对农村中老年人抑郁和生活满意度的影响，并进一步探讨了不同居住安排下的照料行为对其心理健康影响的差异。研究发现：（1）照料孙辈对农村中老年人抑郁症状频率有正向影响，对农村流动中老年人的生活满意度有负向影响，但对农村非流动中老年人的生活满意度有正向影响；（2）不和子女、孙辈居住且照料孙辈的农村中老年人生活满意度为好的概率最高，隔代居住且照料孙辈的农村流动中老年人生活满意度为好的概率最低，三代同堂居住且照料孙辈的农村非流动中老年人生活满意度为好的概率最低；（3）代际情感支持比代际经济支持更有利于农村中老年人的心理健康。基于上述结论，本文认为政府应支持兴办农村婴幼儿托管服务机构，为农村流动中老年人提供社会支持服务，支持子女与父母保持"一碗汤的距离"居住，倡导子女增强对父母的精神慰藉。     

中国不同地区中老年人门诊服务利用及影响因素研究

目的 分析中国不同地区中老年居民门诊服务利用现状及其影响因素。方法 基于2018年CHARLS第四次调查,将中国28个省份划分为东中西部三个地区,依据安德森模型对19 136例中老年居民门诊服务利用的影响因素采用二分类多水平Logistic回归模型进行探讨。结果 我国中老年居民慢性病患病率为44.7%,其中,西部地区慢性病患病率最高(47.3%),四周就诊率最高(18.2%); 不同地区中老年居民门诊服务利用的影响因素有所不同,东部地区,女性(男性OR=0.782,95%CI:0.675～0.905)、文化水平较高(OR=1.853,95%CI:1.197～2.869)、丧偶者(OR=1.317,95%CI:1.081～1.605)四周就诊的可能性增加; 在中部地区,参加城镇职工医保(OR=2.094,95%CI:1.123～3.903)或新农合(OR=1.952,95%CI:1.069～3.563)、轻度失能(OR=1.440,95%CI:1.099～1.885)的居民四周就诊的可能性增加; 在西部地区,女性四周就诊的可能性高于男性(OR=0.718,95%CI:0.628～0.821); 三个地区均显示自评健康状况越差、慢性病患者四周就诊的可能性更高(P＜0.05)。结论 我国不同地区中老年居民门诊服务利用的影响因素有所不同,自评健康状况和慢性病是三个地区四周就诊率相同的影响因素因此,在配置门诊医疗资源时,应针对不同地区的中老年人群特点进行合理倾斜。     

Smoking, prevalence of disease and health service utilization among the Swiss population

The data of the 1981-83 Swiss National Health Survey "SOMIPOPS", based on a randomly selected sample of 4,235 individuals aged 20 or over representative of the whole Swiss population, were used to investigate the relation between smoking, prevalence of disease and frequency of health care utilization. The risks of several conditions, including hypertension, myocardial infarction and other heart diseases, asthma, tuberculosis and kidney disease were elevated among ex-smokers. The diseases showing elevated risks among current smokers and significantly positive dose-risk trends included acute bronchitis (relative risk, RR = 3.2 for heavy cigarette smokers vs never smokers), chronic bronchitis or lung emphysema (RR = 2.0), gastro-duodenal ulcer (RR = 1.8) and bone fractures (RR = 1.6). For respiratory conditions, the risk of pipe or cigar smokers was comparable to that of moderate cigarette smokers, whereas for ulcer (RR = 4.1) or fractures (RR = 2.0) the point estimates were even higher than for heavy cigarette smokers. Smokers tended to consult more frequently general practitioners, used more other outpatients services, and were more frequently admitted to hospital during the year preceding the interview. These effects were consistent across strata of age, socio-economic indicators, and persisted after allowance for major identified potential distorting factors. Thus, the results of this survey confirm that smoking is an important cause of morbidity and a major contributory factor to the use of health services.     

Health service demand and utilization among rural elderly in Hebei province

Objective To examine health service demand and utilization among rural residents aged ≥ 60 years in Hebei province. Methods Using stratified multistage cluster sampling, we conducted face-to-face interviews among 2 892 residents ≥ 60 years in 12 villages of 3 municipalities, Hebei province during July – September 2019. A self-designed questionnaire was used to collect participants′ information on health service demand, utilization and accessibility. Results Among the participants surveyed, the prevalence of chronic diseases was 79.1%;the two-week prevalence rate was 20.5%;12.4% reported ever visiting a doctor during past two weeks;34.4% reported with illness to be treated but not seeking medical service during past two weeks;26.6% reported having hospitalization during previous one year and 46.8% reported with diseases needing hospitalization treatment but not having hospitalization. The reported top three reasons for not seeking medication during past two weeks and not having a required hospitalization during past one year were self-perceived mild illness, economic difficulty, and inconvenient transportation. The difference in health service accessibility was statistically significant among the participants living in regions with different social development levels (P < 0.05);the participants′ health service demand and utilization differed significantly by some sociodemographic features (P < 0.05 for all). Conclusion The health service demand is at a high level but the health service utilization is at a low level among rural elderly in Hebei province, suggesting that medical insurance and health resource allocation should be improved to promote health service utilization of the population. © 2022 Editorial Office of Chinese Journal of Public Health. All rights reserved.