University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Mary-Somerville-Straße 5, 28359, Bremen, Germany.
University of Bremen, High-Profile Area Health Sciences, Bremen, Germany.
Int J Equity Health. 2020 Feb 7;19(1):22. doi: 10.1186/s12939-020-1130-z.
Elderly in need of long-term care tend to have worse health and have higher need of medical care than elderly without need for long-term care. Yet, characteristics associated with long-term care need can impede health care access: Higher levels of long-term care need come with physical and cognitive decline such as frailty and memory loss. Yet, it has not been investigated whether level of long-term care need is related to medical care utilization.
We investigated the association between the level of long-term care and medical specialist utilization among nursing home residents and home care recipients. We applied zero-inflated Poisson regression with robust standard errors based on a sample of statutory health insurance members. The sample consisted of 100.000 elderly over age 60. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner utilization.
We found a strong gradient effect of the level of long-term care for 9 out of 12 medical specialties: A higher level of long-term care need was associated with a lower probability of having a medical specialist visit. Yet, we did not find clear effects of the level of long-term care need on the intensity of medical specialist care. These findings were similar for both the nursing home and home care setting.
The findings indicate that inequalities in medical specialist utilization exist between elderly with differing levels of long-term care need because differences in morbidity were controlled for. Elderly with higher need of long-term care might face more access barriers to specialist medical care.
需要长期护理的老年人往往健康状况较差，对医疗保健的需求也高于无需长期护理的老年人。然而，与长期护理需求相关的特征可能会阻碍医疗保健的获取：更高水平的长期护理需求伴随着身体和认知能力下降，如虚弱和记忆力减退。然而，长期护理需求水平是否与医疗保健的利用有关尚未得到调查。
我们研究了养老院居民和家庭护理接受者的长期护理水平与医疗专家利用之间的关系。我们根据法定健康保险成员的样本应用了零膨胀泊松回归和稳健标准误差。该样本包括 100,000 名 60 岁以上的老年人。我们控制了年龄、性别、发病率和死亡率、居住密度以及全科医生的利用情况。
我们发现，12 种医疗专业中的 9 种存在长期护理水平的强烈梯度效应：较高水平的长期护理需求与接受医疗专家就诊的概率较低相关。然而，我们没有发现长期护理需求水平对医疗专家护理强度的明确影响。这些发现无论是在养老院还是家庭护理环境中都是相似的。
这些发现表明，由于控制了发病率的差异，不同长期护理需求水平的老年人在医疗专家利用方面存在不平等。需要长期护理的老年人可能面临更多的专科医疗保健获取障碍。
