Dunlop Dorothy D, Manheim Larry M, Song Jing, Chang Rowland W
Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Illinois 60208, USA.
J Gerontol B Psychol Sci Soc Sci. 2002 Jul;57(4):S221-33. doi: 10.1093/geronb/57.4.s221.
We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults.
Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access.
African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare.
Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.
我们研究了经济可及性在老年人医疗服务使用中的性别和种族差异方面所起的作用。
利用1993 - 1995年关于高龄老人健康动态资产（AHEAD）的研究数据，调查按性别以及非西班牙裔白人相对于少数族裔（西班牙裔和非裔美国人）群体在两年内医疗服务使用情况的差异。分析考虑了易患因素、健康需求和经济可及性。
在控制了易患因素和需求指标后，与非西班牙裔白人男性相比，非裔美国男性看医生的次数较少；少数族裔和非西班牙裔白人女性使用医院或门诊手术服务较少；少数族裔男性接受门诊手术较少；西班牙裔女性使用养老院护理的可能性较小。尽管经济可及性与一些医疗利用情况有关，但它对医疗保险覆盖的服务的性别/种族差异影响不大。然而，经济可及性导致了牙科护理方面的少数族裔差异，而牙科护理不在医疗保险覆盖范围内。
医疗保险在为老年女性和少数族裔提供医疗服务方面发挥了重要作用。在健康需求水平相似的老年人中，经济可及性并不能解释医疗保险覆盖的医疗服务使用中存在的显著性别和种族差异。其他文化和态度因素值得研究以解释这些性别/种族差异。
