Haggerty Jeannie L, Levesque Jean-Frédéric
McGill University.
Can J Public Health. 2015 Feb 4;106(2):e66-71. doi: 10.17269/cjph.106.4562.
Direct measures of health care affordability from the user perspective are needed to monitor equitable access to publicly funded health care in Canada. The objective of our study was to develop a survey-based measure of healthcare affordability applicable to the Canadian context.
We developed items after focus group exploration of access and cost barriers in the healthcare trajectory. We administered an initial instrument by telephone to a randomly-selected sample of 750 respondents in metropolitan, rural, and remote settings in Quebec. After analysis we developed a new, self-administered version eliciting the frequency of problem access due to five affordability dimensions. This version was mailed to a subset of participants. We conducted exploratory and confirmatory factor analysis. We used ordinal logistic regression modelling to examine how individual items and the subscale score predicted indicators of difficult access. We looked for effect modification by income categories.
The five items load on a single construct with good internal consistency (α = 0.77). The overall score, 0 to 5, reflects the sum of problems with healthcare affordability due to direct and indirect costs. The item and subscale scores are sensitive to income status, with affordability problems more prevalent among low-income than high-income respondents. Each unit increase in the subscale score predicts increased likelihood of unmet needs (OR = 1.54), emergency room use (OR = 1.41), and health problem aggravation (OR = 1.80).
This subscale reliably and validly measures cost barriers to medically necessary services in Canada, and can potentially be applied in other settings with publicly funded health systems. It can be used to monitor and compare healthcare equity.
需要从用户角度对医疗保健可负担性进行直接测量，以监测加拿大公共资助医疗保健的公平可及性。我们研究的目的是开发一种适用于加拿大情况的基于调查的医疗保健可负担性测量方法。
在对医疗保健过程中的可及性和成本障碍进行焦点小组探讨后，我们制定了相关条目。我们通过电话对魁北克省大城市、农村和偏远地区随机抽取的750名受访者样本进行了初步调查。经过分析，我们开发了一个新的自填式版本，该版本引出了由于五个可负担性维度导致的问题可及性的频率。这个版本被邮寄给了一部分参与者。我们进行了探索性和验证性因素分析。我们使用有序逻辑回归模型来检验各个条目和子量表得分如何预测难以获得医疗服务的指标。我们研究了收入类别对结果的影响。
这五个条目加载在一个单一结构上，具有良好的内部一致性（α = 0.77）。总体得分从0到5，反映了由于直接和间接成本导致的医疗保健可负担性问题的总和。条目和子量表得分对收入状况敏感，低收入受访者比高收入受访者更容易出现可负担性问题。子量表得分每增加一个单位，预测未满足需求的可能性增加（OR = 1.54）、急诊室使用的可能性增加（OR = 1.41）以及健康问题恶化的可能性增加（OR = 1.80）。
这个子量表可靠且有效地测量了加拿大医疗必需服务的成本障碍，并且有可能应用于其他有公共资助卫生系统的环境中。它可用于监测和比较医疗保健公平性。
