How Poverty, Residence Status and Health Insurance Predict Unmet Healthcare Needs among Chinese Elders?

This study focuses on the variability in unmet healthcare needs among vulnerable Chinese elders and the degree to which these unmet needs are associated with socioeconomic disadvantages. We use the 2013 wave of China Health and Retirement Longitudinal Study (CHARLS) and a multinomial logistic model to investigate how poverty, residence status and particular health insurance schemes influence unmet healthcare needs independently and in combination. Our results show that poverty and rural residence are strong predictors of unmet healthcare needs due to financial and non-financial constraints, respectively. Although health insurance can reduce financial barriers, its influence varies with different insurance schemes, thus generating unequal healthcare access among heterogeneous vulnerable subgroups of elders and putting poor rural migrants at the highest risk for unmet healthcare needs. Our findings direct attention to the differences in resources available to various subgroups of elders and the importance of social stratification in predicting unmet health care needs.

Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals

Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.

Associations of Health Conditions and Health-Related Determinants with Disability among New York City Adult Residents

Introduction: Population-based disability prevalence estimates are limited for New York City (NYC). We examined the associa­tion of several health and health-related measures with disability among NYC resi­dents aged 20-64 years.Methods: We used information from 1,314 adults who participated in the 2013-2014 NYC Health and Nutrition Examination Sur­vey (HANES). We categorized survey partici­pants as having a disability if they reported a physical, mental, and/or emotional problem preventing work or if they reported difficulty walking without special equipment because of a health problem. We used log-binomial regression to quantify the association of each exposure with disability before and after adjustment for select covariates.Results: Overall, 12.4% of the study’s NYC residents aged 20-64 years had a disabil­ity. After adjustment, disability prevalence was significantly greater among those who reported having unmet health care needs (prevalence ratio [PR] = 1.75, 95% CI: 1.18-2.57) and those who reported fair/ poor general health (PR = 2.33, 95% CI: 1.68-3.24). The probability of disability was greater among NYC residents with arthritis (PR = 2.66, 95% CI: 1.85-3.98) and hy­pertension (PR = 1.48, 95% CI: 1.04-2.11) when compared with those without these conditions. Disability was also associated with depression (PR = 2.96, 95% CI: 2.06- 4.25), anxiety (PR = 2.89, 95% CI: 2.15- 3.88), and post-traumatic stress disorder (PR = 2.55, 95% CI: 1.66-3.91). Disability, however, was not associated with diabetes.Conclusion: Disability is more prevalent among those with unmet health care needs, fair/poor general health, arthritis, hyperten­sion, depression, anxiety, and PTSD in these NYC residents, aged 20-64 years. These findings have implications for NYC’s strate­gic planning initiatives, which can be better targeted to groups disproportionately affect­ed by disability.Ethn Dis. 2021;31(3):445- 452; doi:10.18865/ed.31.3.445

Assessing unmet health-care needs of the elderly in west of Iran: A case study

Purpose The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran). Design/methodology/approach This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services. Findings The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services. Originality/value The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

Gendered Association Between Employment Status and Unmet Health Care Needs Among Middle-Aged Koreans

Previous studies show that working people are less likely to experience unmet health care needs than non-workers. Also, employment and health are located in gendered social contexts. The present study aims to examine the moderating effect of gender on the association between employment status and unmet health care needs among middle-aged Koreans. We conducted logistic regression using the Korean Health Panel data (in 2016 and 2017; N=2,573, age range=45-64). Having experiences unmet health care needs in 2017 was the binary dependent variable. Employment status in 2016 was the binary independent variable and gender was the moderating variable. Age, education level, marital status, annual income, household type, type of medical security, disability, self-rated health, the number of chronic diseases, and stress level in 2016 were also in the analytic model based on the Andersen’s health behavioral model. The percentages of middle-aged people experiencing unmet health care needs were 18% for working men, 11% for non-working men, 13% for working women, and 16% for non-working women. The result showed there was significant moderating effect of gender (B= .72, p< .05). Specifically, working men were less likely to experience unmet health care needs than non-working men. On the contrary, there was not the significant difference in experiencing unmet health care needs between working and non-working women. It indicates that it is necessary to supplement medical services for especially for middle-aged men who are not employed because they might experience considerable amounts of unmet health care needs.