Department of Economics, University of Karachi, Karachi, 75270, Pakistan.
New ERA, Rudramati Marga, Bagmati, Kalopul, Kathmandu, 44600, Nepal.
BMC Geriatr. 2021 Jan 12;21(1):42. doi: 10.1186/s12877-021-02005-3.
In Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.
This study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014-15. We followed the Anderson's Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.
Out of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5-4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82-1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84-1.13) and richest (AOR: 1.29, 95%CI 0.89-1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.
Our findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.
在巴基斯坦，医疗体系正面临前所未有的挑战，难以满足日益增长的老年人口的医疗需求。本研究旨在利用概念框架，分析与老年人选择在私人和公立医院就诊相关的因素。
本研究使用了 2014-15 年巴基斯坦社会和生活水平测量调查中抽取的 5319 名 60 岁及以上个体的样本。我们遵循安德森的医疗保健利用行为模型，使用探索性数据分析和二元逻辑回归分析与医疗保健利用相关的行为因素，包括倾向因素、促成因素和需求因素。本研究中医疗服务的利用是指到私人和政府医院就诊。
在 5319 名参与者中，约四分之三（72.4%）的人因医疗需求到私人医院就诊。多变量分析显示，年龄较大的人群（80 岁及以上）和来自城市的参与者分别更有可能到私人医院就诊（OR：1.35，95%CI 1.13-1.62；OR：1.53，95%CI 1.30-1.80）。来自开伯尔-普赫图赫瓦的老年人到政府医院就诊的可能性是旁遮普的老年人的三倍（OR：3.29，95%CI 2.50-4.80）。上过学的参与者（OR：1.21，95%CI 0.82-1.31）更有可能到私人医院就诊。来自富有（OR：1.04，95%CI 0.84-1.13）和最富（OR：1.29，95%CI 0.89-1.87）财富五分位数的老年人更有可能在私人医院使用医疗服务。与单次就诊相比，就诊次数为 3 次或以上的私人医院就诊的可能性高 1.7 倍，公共医院就诊的可能性高 1.5 倍。
本研究结果突显了扩大老年人口医疗服务覆盖范围的迫切需要。这需要有效实施旨在改善公平获得私人医疗服务的政策，并升级政府医院。此外，通过这项研究获得的知识可以用于使社会保护计划更好地满足与年龄相关的医疗需求，并侧重于照顾没有配偶的老年人。
