Faculty of Nursing, University of Iceland, Iceland.
Scand J Public Health. 2021 Dec;49(8):875-883. doi: 10.1177/1403494820944096. Epub 2020 Aug 29.
Equity of access to medical care is a central objective in socialised and national health insurance systems. Based on a national panel survey of Icelandic adults, the study examined the effects of family income on insufficient medical care and whether income-related differences were explained by overall financial strain, health-care cost burden, cultural variables or barriers related to health-system obstacles or experiences. The study used two-wave panel data from national postal health surveys of Icelandic adults aged 18-75. Insufficient medical care was assessed in terms of both reported delay/cancellation of physician care and estimated underutilisation when comparing actual and professionally recommended physician visits. The study found that individuals with lower family incomes were more likely to delay or cancel a needed physician visit and underutilise medical care compared to their higher-income counterparts. High relative out-of-pocket costs, overall financial strain and negative experiences of medical care fully accounted for the disadvantaged medical access of lower-income individuals. The most important explanatory variable was out-of-pocket costs, as it affected insufficient medical care both directly and indirectly by compounding economic difficulties in the family. Attitudes, beliefs and health-related behaviours had limited effects on insufficient medical care and did not account for income-related differences.
医疗保健公平可及是社会化和国家医疗保险制度的核心目标。本研究基于冰岛成年人的全国性面板调查，探讨了家庭收入对医疗服务不足的影响，以及收入相关差异是否可以用总体经济压力、医疗费用负担、文化变量或与卫生系统障碍或体验相关的障碍来解释。本研究使用了来自冰岛 18-75 岁成年人的全国邮政健康调查的两波面板数据。根据报告的医生护理延迟/取消情况和实际与专业推荐的医生就诊次数进行比较，评估医疗服务不足。研究发现，与高收入者相比，家庭收入较低的个体更有可能延迟或取消必要的医生就诊，并过度利用医疗服务。相对较高的自付费用、总体经济压力和对医疗服务的负面体验完全解释了低收入个体医疗服务获取的不利情况。最重要的解释变量是自付费用，因为它直接和间接地通过家庭经济困难的累积对医疗服务不足产生影响。态度、信念和与健康相关的行为对医疗服务不足的影响有限，不能解释收入相关的差异。
