Yamada Tetsuji, Chen Chia-Ching, Murata Chiyoe, Hirai Hiroshi, Ojima Toshiyuki, Kondo Katsunori, Harris Joseph R
Department of Economics, Center for Children and Childhood Studies, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA.
Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, 95 Grasslands Rd., Valhalla, NY 10595, USA.
Int J Environ Res Public Health. 2015 Feb 3;12(2):1745-72. doi: 10.3390/ijerph120201745.
The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003-2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.
本研究的目的是调查可能导致老年人医疗需求延迟和未得到满足的医疗服务可及性差异，并审视老年人的健康不平等和医疗成本负担。为了得出明确的政策应用建议，本研究采用了一种经过改进的PRECEDE-PROCEED模型来构建理论和实验方法。数据收集自美国2003 - 2004年社区追踪研究家庭调查的大量样本。检验了可靠性和结构效度以确保内部一致性，并使用概率单位/普通最小二乘法回归分析了差异和不平等情况。结果表明， predisposing因素（例如，态度、信念以及社会人口统计学差异导致的认知）与延迟医疗服务呈负相关。促成因素（例如，医疗保险覆盖范围的可及性以及医疗服务提供者的常见来源）增加10%，与医疗融资因素增加1%显著相关。此外，通过社会经济网络和支持系统获取的信息对可及性差异有5%的影响。收入、健康状况和健康不平等是由外部因素决定的。设计并实施便捷的医疗服务可及性（医疗系统）和医疗融资方法，以及建立社会经济支持网络（包括公共卫生信息）对于减少延迟医疗服务和健康不平等至关重要。
