Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria.
Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria.
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DOI：
10.1186/1472-6963-11-153
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发表时间：
2011-06-28
影响因子：
2.8
通讯作者：
Prince MJ
中科院分区：
文献类型：
--
作者：
Albanese E;Liu Z;Acosta D;Guerra M;Huang Y;Jacob KS;Jimenez-Velazquez IZ;Llibre Rodriguez JJ;Salas A;Sosa AL;Uwakwe R;Williams JD;Borges G;Jotheeswaran AT;Klibanski MG;McCrone P;Ferri CP;Prince MJ
描述中低收入国家老年人近期卫生服务利用模式以及随之而来的自付费用，并评估获得和提供服务的公平性。在九个国家（中国、印度、墨西哥和秘鲁的城市和农村地区，古巴、多米尼加共和国、波多黎各和委内瑞拉的城市地区，以及尼日利亚的一个农村地区）的地理定义的流域内，对 17,944 名 65 岁及以上的人进行了一阶段基于人口的横断面调查。主要结果是过去 3 个月内社区卫生保健服务的使用情况。使用泊松回归生成患病率和固定效应荟萃分析来结合需求指标（痴呆、抑郁、身体损伤）、诱发因素（年龄、性别和教育）和促成因素（家庭资产、养老金收入和健康保险）来估计独立关联。不同地点使用医疗保健服务的比例从 6% 到 82% 不等。身体损伤的数量（汇总患病率 1.37，95% CI 1.26-1.49）和 ICD-10 抑郁发作（汇总 PR 1.21，95% CI 1.07-1.38）与服务使用相关，但痴呆症呈负相关（汇总 PR 0.93，95% CI 0.90-0.97）。其他相关因素包括女性、高等教育、更多的家庭资产、领取养老金和健康保险。年龄、性别、身体损伤、抑郁和痴呆的标准化并不能解释服务使用的差异。需要自付费用的咨询比例与卫生服务使用率之间存在很强的临界显着生态相关性（r = -0.50，p = 0.09）。虽然几乎没有证据表明存在年龄歧视，但教育和健康保险保险的独立促进作用中的不平等现象很明显，后者尤其是在自付费用很常见的地方，而私人健康保险是医疗保健融资的重要组成部分。各站点服务使用的差异最有可能的原因是自付费用的程度以及老年人及其家庭的支付能力存在明显差异。通过自付费用为医疗服务提供资金的卫生系统有可能将最贫困的老年人、没有稳定固定收入的人和没有保险的人排除在外。
To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered. 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them. The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09). While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured.
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影响因子：
12.7
作者：
Subramanian, SV;Nandy, S;Smith, GD
通讯作者：
Smith, GD
影响因子：
10.5
作者：
Chisholm, D;Sekar, K;Murthy, RS
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168.9
作者：
Sousa, Renata M.;Ferri, Cleusa P.;Prince, Martin
通讯作者：
Prince, Martin
影响因子：
6.9
作者：
Patel, V;Prince, M
通讯作者：
Prince, M
影响因子：
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作者：
Copeland, JRM;Prince, M;Gurland, B
通讯作者：
Gurland, B