哥伦比亚老年人医疗保健使用的不平等现象。
Inequality in healthcare use among older people in Colombia.
机构信息
Research group GIPSPE, University of Caldas, Manizales, Colombia.
Department of Health Policy, The London School of Economics and Political Science, London, UK.
出版信息
Int J Equity Health. 2020 Oct 26;19(1):168. doi: 10.1186/s12939-020-01241-0.
BACKGROUND
Since the early 1990s, Colombia has made great strides in extending healthcare coverage to its population. In order to measure the impact of these efforts, it is important to assess whether the introduction of universal health coverage has translated into equitable access to healthcare in the country, particularly for the elderly. Thus, in this study we assessed the inequality in utilization of health services among elderly patients in Colombia. In addition, we identified the determinants of healthcare utilization.
METHODS
We analyzed the 2015 Colombian health, well-being and aging study (SABE). To classify determinants of healthcare use into predisposing, enabling and need factors, we employed the Anderson framework of healthcare utilization. Use of outpatient, inpatient and preventive health services constituted the dependent variables. We performed multivariate logistic regressions, estimated concentration indexes (CI) and performed decomposition analyses of the CIs to determine the contribution of various determinants to inequality of healthcare utilization.
RESULTS
The study sample included 23,694 adults over 60-years-old. Wealth quintile, urban dwelling, health insurance type and multimorbidity predicted the utilization of all types of healthcare services except for hospitalization. Aside from inpatient care, pro-rich inequality in utilization of healthcare services was present. Wealth quintile and type of health insurance were the largest contributors to pro-rich inequality in use of preventive services.
CONCLUSIONS
While there has been progress in health insurance coverage for the elderly in Colombia, there are still equality challenges in the delivery of healthcare, especially for preventive and outpatient care. These inequalities are driven by individual characteristics such as wealth, urban residence, type of health insurance carried, and presence of multimorbidity. To address this issue, the Colombian health system should extend health insurance coverage to uninsured populations, as well as reduce barriers of access to healthcare services among poorest and the rural population receiving subsidized insurance.
背景
自 20 世纪 90 年代初以来，哥伦比亚在扩大其人口医疗保健覆盖范围方面取得了重大进展。为了衡量这些努力的影响，重要的是要评估全民医疗保险的引入是否转化为该国医疗保健的公平获得，特别是老年人的医疗保健。因此，在这项研究中，我们评估了哥伦比亚老年患者卫生服务利用的不平等情况。此外，我们确定了医疗保健利用的决定因素。
方法
我们分析了 2015 年哥伦比亚健康、福利和老龄化研究（SABE）。为了将医疗保健使用的决定因素分类为倾向因素、促成因素和需求因素，我们采用了安德森医疗保健利用框架。门诊、住院和预防保健服务的使用构成了因变量。我们进行了多变量逻辑回归、估计集中指数（CI）并对 CI 进行分解分析，以确定各种决定因素对医疗保健利用不平等的贡献。
结果
研究样本包括 23694 名 60 岁以上的成年人。财富五分位数、城市居住、医疗保险类型和多种疾病预测了除住院外所有类型的医疗保健服务的使用。除了住院护理外，还存在医疗服务利用的亲富不平等。财富五分位数和医疗保险类型是预防服务利用亲富不平等的最大贡献者。
结论
尽管哥伦比亚在老年人医疗保险覆盖方面取得了进展，但在医疗保健提供方面仍存在公平挑战，特别是在预防和门诊护理方面。这些不平等是由个人特征驱动的，如财富、城市居住、所拥有的医疗保险类型以及多种疾病的存在。为了解决这个问题，哥伦比亚的卫生系统应该将医疗保险覆盖范围扩大到未参保人群，并减少最贫困和接受补贴保险的农村人口获得医疗保健服务的障碍。
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