Inequities in health care utilization by people aged 50+: Evidence from 12 European countries
Inequities in health care utilization by people aged 50+: Evidence from 12 European countries
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DOI：
10.1016/j.socscimed.2014.12.028
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发表时间：
2015-02-01
影响因子：
5.4
通讯作者：
Terraneo, Marco
中科院分区：
文献类型：
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作者：
Terraneo, Marco
这项研究的目的是描述12个欧洲国家50岁以上的人在使用卫生保健服务方面的教育不平等程度，并控制国家一级的异质性。我们考虑四种服务：1)看过全科医生(GP)或2)看过专科医生，3)住院过，4)看过牙医(只是为了预防)。数据来自SHARE(欧洲健康、老龄化和退休调查)项目，这是一个跨国小组，收集50岁及以上个人的信息。采用固定效应法，为传统的多水平模型在国别比较分析中的应用提供了一种有价值的选择。这项研究的主要结果证实，尽管不同服务之间存在相关差异，但在卫生保健的使用方面存在严重的教育不平等。在专科医生和牙医就诊方面，发现了明显的受教育程度差异，而在使用全科医生方面，没有发现教育差异的证据。另一方面，在住院方面出现了不太明确的结果。然而，分析表明，微观层面(即个人需求和易感和促进人口特征)与宏观层面因素(医疗保健制度和福利制度)相互作用，决定了人们对卫生服务的使用。可以得出的结论是，受教育程度越高的人拥有更多的资源(认知、沟通、关系)，使他们能够为自己的健康目标做出更明智的选择并采取更有效的行动，然而，制度背景可能会改变这种关系。(C)2014爱思唯尔有限公司。保留所有权利。
The aim of this study is to describe the magnitude of educational inequities in the use of health care services, by people aged 50+, in 12 European countries, controlling for country-level heterogeneity. We consider four services: having seen or talked to 1) a general practitioner (GP) or 2) specialist, 3) having been hospitalized, and 4) having visited a dentist (only for prevention). Data derived from the SHARE (Survey of Health, Ageing and Retirement in Europe) project, a cross-national panel that collects information from individuals aged 50 and over. A Fixed Effects approach is applied, which is a valuable alternative to the application of conventional multilevel models in country-comparative analysis. The main findings of this study confirm that there is substantial educational inequity in the use of health care, although relevant differences arise between services. A clear pro-educated gradient is found for specialists and dentist visits, whereas no evidence of educational disparities was found for GP use. On the other hand, less clear results emerge regarding hospitalizations. However, the analysis shows that microlevel dimensions, i.e. individual needs and predisposing and enabling population characteristics, and macro level factors, i.e. health care system and welfare regime, interact to determine people's use of health services. It can be concluded that people with more education level have more resources (cognitive, communicative, relational) that allow them to make more informed choices and take more effective actions for their health goals, however, the institutional context may modify this relationship. (C) 2014 Elsevier Ltd. All rights reserved.