Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization

2021 ◽  
pp. 002073142098192
Author(s):  
Saruna Ghimire ◽  
Devendra Raj Singh ◽  
Sara J. McLaughlin ◽  
Renusha Maharjan ◽  
Dhirendra Nath
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Concentration Curve ◽  
Horizontal Equity ◽  
Family Type ◽  
Care Utilization ◽  
Vertical Equity ◽  
Cross Sectional ◽  
The Government

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen’s theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government’s free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.

Horizontal Equity in Health Care Utilization in Canada

2006 ◽  
Author(s):  
Michel Grignon ◽  
Jeremiah Hurley ◽  
Alina Gildiner ◽  
Martin Hering
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Horizontal Equity ◽  
Care Utilization ◽  
Equity In Health ◽  
Equity In Health Care

scholarly journals Health Care Utilization and Symptom Severity in Ghanaian Children – a Cross-Sectional Study

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e80598 ◽  
Author(s):  
Ralf Krumkamp ◽  
Nimako Sarpong ◽  
Benno Kreuels ◽  
Lutz Ehlkes ◽  
Wibke Loag ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Symptom Severity ◽  
Cross Sectional Study ◽  
Care Utilization ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Fortune N. Nyamande ◽  
Paola A. Mosquera ◽  
Miguel San Sebastián ◽  
Per E. Gustafsson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Horizontal Equity ◽  
Care Utilization ◽  
Northern Sweden ◽  
Equity In Health ◽  
Percentage Points ◽  
Low Educated ◽  
Equity In Health Care

Abstract Background Knowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach. Methods Data on participants (N = 22,997) aged 16–84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization. Results Joint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40–9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67–5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56–6.19), but with no significant horizontal inequity – by gender, education, or their combination – remaining after needs adjustment. Conclusion This study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.

scholarly journals Comparison of health care utilization among patients affiliated and not affiliated with healthcare professionals in China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yafei Si ◽  
Zhongliang Zhou ◽  
Min Su ◽  
Han Hu ◽  
Zesen Yang ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Healthcare Professionals ◽  
Outpatient Visit ◽  
Labour Force ◽  
Care Utilization ◽  
Exact Matching ◽  
Quality Health Care ◽  
Cross Sectional ◽  
Quality Health

Abstract Background Doing “more” in healthcare can be a major threat to the delivery of high-quality health care. It is important to identify the supplier-induced demand (SID) of health care. This study aims to test SID hypothesis by comparing health care utilization among patients affiliated with healthcare professionals and their counterpart patients not affiliated with healthcare professionals. Methods We used coarsened exact matching to compare the health care utilization and expenditure between patients affiliated and not affiliated with healthcare professionals. Using cross-sectional data of the China Labour-force Dynamics Survey (CLDS) in 2014, we identified 806 patients affiliated with healthcare professionals and 22,788 patients not affiliated with healthcare professionals. The main outcomes were outpatient proportion and expenditure as well as inpatient proportion and expenditure. Results The matched outpatient proportion of patients not affiliated with healthcare professionals was 0.6% higher (P = 0.754) than that of their counterparts, and the matched inpatient proportion was 1.1% lower (P = 0.167). Patients not affiliated with healthcare professionals paid significantly more (680 CNY or 111 USD, P < 0.001) than their counterparts did per outpatient visit (1126 CNY [95% CI 885–1368] vs. 446 CNY [95% CI 248–643]), while patients not affiliated with healthcare professionals paid insignificantly less (2061 CNY or 336 USD, P = 0.751) than their counterparts did per inpatient visit (15583 CNY [95% CI 12052–19115] vs. 17645 CNY [95% CI 4884–30406]). Conclusion Our results lend support to the SID hypothesis and highlight the need for policies to address the large outpatient care expenses among patients not affiliated with healthcare professionals. Our study also suggests that as the public becomes more informed, the demand of health care may persist while heath care expenditure per outpatient visit may decline sharply due to the weakened SID. To address misbehaviors and contain health care costs, it is important to realign provider incentives.

Leisure-Time Physical Activity and Health-Care Utilization in Older Adults

2006 ◽  
Vol 14 (4) ◽  
pp. 392-410 ◽  
Author(s):  
Michelle Y. Martin ◽  
M. Paige Powell ◽  
Claire Peel ◽  
Sha Zhu ◽  
Richard Allman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Community Dwelling ◽  
Care Utilization ◽  
Physically Active ◽  
Physician Visits

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N= 1,000, 75.32 ± 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.

scholarly journals Healthcare utilization among migrants to the UK: cross-sectional analysis of two national surveys

2020 ◽  
Vol 26 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Catherine L Saunders ◽  
Adam Steventon ◽  
Barbara Janta ◽  
Mai Stafford ◽  
Carol Sinnott ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Dental Care ◽  
Odds Ratio ◽  
Service Planning ◽  
Care Utilization ◽  
Cross Sectional ◽  
Objective Evidence ◽  
The Uk

Objective To contribute objective evidence on health care utilization among migrants to the UK to inform policy and service planning. Methods We analysed data from Understanding Society, a household survey with fieldwork from 2015 to 2017, and the European Health Interview Survey with data collected between 2013 and 2014. We explored health service utilization among migrants to the UK across primary care, inpatient admissions and maternity care, outpatient care, mental health, dental care and physiotherapy. We adjusted for age, sex, long-term health conditions and time since moving to the UK. Results Health care utilization among migrants to the UK was lower than utilization among the UK-born population for all health care dimensions except inpatient admissions for childbirth; odds ratio (95%CI) range 0.58 (0.50–0.68) for dental care to 0.88 (0.78–0.98) for primary care). After adjusting for differences in age and self-reported health, these differences were no longer observed, except for dental care (odds ratio 0.57, 95%CI 0.49–0.66, P < 0.001). Across primary care, outpatient and inpatient care, utilization was lower among those who had recently migrated, increasing to the levels of the nonmigrant population after 10 years or more since migrating to the UK. Conclusions This study finds that newly arrived migrants tend to utilize less health care than the UK population and that this pattern was at least partly explained by better health, and younger age. Our findings contribute nationally representative evidence to inform public debate and decision-making on migration and health.

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