Socioeconomic Status and Utilization of Health Care Services in Canada and the United States Findings From a Binational Health Survey
Socioeconomic Status and Utilization of Health Care Services in Canada and the United States Findings From a Binational Health Survey
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DOI：
10.1097/mlr.0b013e3181adcbe9
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发表时间：
2009-11-01
期刊：
影响因子：
3
通讯作者：
Berthelot, Jean-Marie
中科院分区：
文献类型：
--
作者：
Blackwell, Debra L.;Martinez, Michael E.;Berthelot, Jean-Marie
目的：基于Andersen的卫生保健服务利用行为模型，我们研究了加拿大和美国成年人利用医生和医院服务的相关因素，重点是社会经济地位（在Andersen的框架中的使能资源）。利用2002-2003年加拿大/美国联合健康调查，我们进行了特定国家的多变量逻辑回归，预测过去一年中的医生接触/访问和过夜住院，控制了易感特征，使资源，以及代表对卫生保健的感知需求的几个因素。所有的分析进行了适当的加权，以产生全国代表性results.Results：几项措施的社会经济地位，有一个定期的医生，教育，并在美国的收入和保险覆盖范围与医生接触或访问在这两个国家，沿着与各种诱因和需要的因素。然而，在这两个国家，这些措施与住院治疗无关。相反，在加拿大和美国，只有个人的易感性特征（如年龄和性别）和他/她对医疗保健的需求预测了医院服务的利用率。在美国的保险覆盖状况成为一个显着的预测住院计数数据进行分析时，通过Poisson regression.Conclusions：鉴于我们的特定结果的措施，在加拿大和美国的成年人表现出类似的模式，医院的利用率，社会经济地位没有起到解释作用。然而，相对于加拿大成年人，在调整医疗保健需求和易感特征后，我们发现美国成年人在医生接触方面存在差异--收入较高的人和收入较低的人之间、有健康保险的人和没有健康保险的人之间。
Objectives: Building on Andersen's behavioral model for the utilization of health care services, we examined factors associated with utilization of physician and hospital services among adults in Canada and the United States, with a focus on socioeconomic status (enabling resources in Andersen's framework).Methods: Using the 2002-2003 Joint Canada/United States Survey of Health, we conducted country-specific multivariate logistic regressions predicting doctor contacts/visits and overnight hospitalizations in the past year, controlling for predisposing characteristics, enabling resources, and several factors representing perceived need for health care. All analyses were appropriately weighted to yield nationally representative results.Results: Several measures of socioeconomic status-having a regular medical doctor, education, and, in the US income and insurance coverage-were associated with doctor contacts or visits in both countries, along with various predisposing and need factors. However, these same measures were not associated with hospitalizations in either country. Instead, only the individual's predisposing characteristics (eg, age and sex) and his/her need for health care predicted utilization of hospital services in Canada and the United States. Insurance coverage status in the United States became a significant predictor of hospitalizations when count data were analyzed via Poisson regression.Conclusions: Given our particular outcome measures, adults in Canada and the United States exhibited similar patterns of hospital utilization, and socioeconomic status played no explanatory role. However, relative to Canadian adults, we found disparities in doctor contacts among US adults-between those with more income and those with less, between those with health insurance and those without-after adjusting for health care needs and predisposing characteristics.