Hajek André, Bock Jens-Oliver, König Hans-Helmut
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BMC Health Serv Res. 2017 Jan 13;17(1):30. doi: 10.1186/s12913-017-1982-0.
It remains an open question how changes in predisposing, enabling, and need factors affect health care use. Consequently, we aimed to investigate how changes in these variables affect health care use in community-dwelling older persons longitudinally.
Data from two waves of the German Ageing Survey (DEAS), a representative sample of the community-dwelling German population aged ≥40 years, was used. Predictors of visits to general practitioners and specialists as well as hospital stays during a 12-month period were analyzed by fixed effects regressions.
Regressions revealed that the need factors 'self-rated health' and the number of chronic diseases affected all measures of health care use (except for the number of chronic diseases on hospital care). An increased duration of physical activities increased GP visits. A decrease of excess weight decreased the number of specialist visits.
Our findings underline the importance of need factors for health care use. Virtually none of the predisposing factors nor enabling resources affected health care use. These findings might indicate that individuals in the second half of life use health care services adequately, i.e. when medically indicated.
易患因素、促成因素和需求因素的变化如何影响医疗保健利用仍是一个悬而未决的问题。因此，我们旨在纵向研究这些变量的变化如何影响社区居住老年人的医疗保健利用情况。
使用了来自德国老龄化调查（DEAS）两轮的数据，该调查是德国≥40岁社区居住人口的代表性样本。通过固定效应回归分析了12个月期间全科医生和专科医生就诊以及住院的预测因素。
回归分析显示，需求因素“自评健康状况”和慢性病数量影响了所有医疗保健利用指标（住院护理方面的慢性病数量除外）。体育活动时长增加会增加全科医生就诊次数。超重情况的减轻会减少专科医生就诊次数。
我们的研究结果强调了需求因素对医疗保健利用的重要性。几乎没有任何易患因素或促成资源影响医疗保健利用。这些结果可能表明，中年及老年个体能在有医疗指征时合理利用医疗保健服务。
