1Department of Development and Sustainability, Development Planning Management and Innovation, Asian Institute of Technology, Pathum Thani, Thailand.
2Higher Education, Archives and Libraries Department, Directorate of Commerce Education and Management Sciences, Khyber Pakhtunkhwa, Pakistan.
Am J Trop Med Hyg. 2021 Jul 19;105(3):837-845. doi: 10.4269/ajtmh.20-1627.
This study aims to explore various barriers in accessing outpatient care among the participants from different age groups and to identify determinants associated with physician visits. The study had adopted Andersen's Behavioral Model (ABM) of Health Services Use. A cross-sectional study design was adopted to collect data from 417 participants through a questionnaire survey. Poisson regression models were used to explore determinants for explaining the differences in outpatient care use. The regression results revealed that divergent relationships existed among age groups. Children and elderly participants tended to decrease the probability of seeking care. Elderly participants confronted more difficulties in access and were dependent on family members. Despite free care provisions, participants visited and spent their out-of-pocket expenditure mostly at non-universal health coverage (non-UHC) facilities. Convenience and the availability of specialist physicians led the higher-income parents to seek care of their children at non-UHC facilities. Highly educated people of working age preferred more self-care or institutionalized care to save time. Children up to the primary level of education were more likely to visit a doctor. We concluded that investments in education or well-informed health services provision would improve health care utilization. Findings of Andersen's Behavioral Model variables suggested that improvements in the quality of services, medical professional skills, and efficient resource allocation may induce seeking care at UHC facilities. Consequently, it will reduce the number of referred cases, caseloads at tertiary care units, and visits to non-UHC facilities at longer distances.
本研究旨在探讨不同年龄组参与者在获得门诊医疗服务方面面临的各种障碍,并确定与医生就诊相关的决定因素。本研究采用了安德森卫生服务利用行为模型(ABM)。采用横断面研究设计,通过问卷调查收集了 417 名参与者的数据。采用泊松回归模型探讨了解释门诊服务利用差异的决定因素。回归结果显示,不同年龄组之间存在不同的关系。儿童和老年参与者就诊的可能性降低。老年参与者在就诊方面遇到更多困难,依赖家庭成员。尽管提供免费医疗服务,但参与者还是在非全民健康覆盖(non-UHC)机构就诊并支付自付费用。便利和专科医生的可用性促使高收入家长选择在非 UHC 机构为孩子就诊。处于工作年龄段的高学历人群更倾向于选择自我护理或机构化护理来节省时间。接受小学及以下教育的儿童更有可能就医。我们得出结论,对教育或知情卫生服务的投资将提高医疗保健的利用率。安德森行为模型变量的研究结果表明,提高服务质量、医疗专业技能和有效资源配置可能会促使人们在 UHC 机构就诊。因此,这将减少转诊病例、三级医疗机构的病例量以及到较远的非 UHC 机构就诊的次数。