Song Jing, Chang Rowland W, Manheim Larry M, Dunlop Dorothy D
Rheumatology Division, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
J Womens Health (Larchmt). 2006 Dec;15(10):1205-13. doi: 10.1089/jwh.2006.15.1205.
Despite Medicare, medical services are not equally used by elderly women and men in the United States. Our purpose is to examine gender differences in healthcare utilization among older Americans, the persistence of gender differences across race/ethnicity, and the roles of sociodemographic, health, and economic factors to explain differences.
Data from the 1998-2000 Health and Retirement Study are used to investigate gender differences in use of hospital, outpatient surgery, home health, and physician services. Analyses are controlled for sociodemographic, health (medical conditions, functional health), and economic (income, wealth, education, health insurance) factors.
Women are significantly less likely to use hospital service (odds ratio [OR]=0.83) and outpatient surgery (OR=0.85) but are more likely to use home health care (OR=1.27) and physician services (OR=1.45), controlling for sociodemographics. Differences in health needs and economic resources partially mediate the gender differences in physician and home healthcare utilization but do not explain the gender differences in hospital service and outpatient surgery. Notably, African American, Hispanic, and white women compared with men show significantly less use of hospital services.
Gender differences in medical use vary according to the type of services used and are largely consistent across racial/ethnic groups. As the size of the Medicare population increases, promoting equitable use of healthcare resources by both women and men is an important issue in developing healthcare policy and designing public health strategies.
尽管有医疗保险，但美国老年女性和男性对医疗服务的使用并不平等。我们的目的是研究美国老年人在医疗保健利用方面的性别差异、种族/族裔间性别差异的持续性，以及社会人口统计学、健康和经济因素在解释这些差异中所起的作用。
利用1998 - 2000年健康与退休研究的数据，调查在医院、门诊手术、家庭健康和医生服务使用方面的性别差异。分析对社会人口统计学、健康（医疗状况、功能健康）和经济（收入、财富、教育、医疗保险）因素进行了控制。
在控制了社会人口统计学因素后，女性使用医院服务（优势比[OR]=0.83）和门诊手术（OR=0.85）的可能性显著较低，但使用家庭医疗保健（OR=1.27）和医生服务（OR=1.45）的可能性较高。健康需求和经济资源的差异部分介导了医生和家庭医疗保健利用方面的性别差异，但无法解释医院服务和门诊手术方面的性别差异。值得注意的是，与男性相比，非裔美国女性、西班牙裔女性和白人女性使用医院服务的情况明显较少。
医疗使用方面的性别差异因所使用服务的类型而异，并且在不同种族/族裔群体中基本一致。随着医疗保险人群规模的增加，促进男女平等使用医疗保健资源是制定医疗保健政策和设计公共卫生战略中的一个重要问题。
