Faculty of Medicine, Department of Public Health, Ege University, Izmir, Turkey.
School of Public Health, University of Nevada Reno (UNR), University of Nevada Reno (UNR), Reno, NV, USA.
BMC Public Health. 2024 Sep 4;24(1):2413. doi: 10.1186/s12889-024-19878-9.
Unmet healthcare needs are a complex and multifaceted issue, influenced by individual, socioeconomic, and healthcare system factors. This study aimed to investigate the determinants influencing cost-related unmet healthcare needs within the Turkish population, emphasizing a comprehensive analysis of gender disparities in accessing healthcare services.
This secondary analysis scrutinizes the 2019 Turkiye Health Survey data of 16,976 individuals aged 15 and older. The dependent variables included cost-related unmet medical, dental, and prescribed medication, and mental services. The independent variables were considered under a three-domain approach for the determination of health service utilization, developed by Andersen. Logistic regression models with predisposing, enabling, and need factors were run for any self-perceived cost-related unmet need for each sex and overall population. Another six regression models for both sexes were run for each subgroup of indivuals with unmet healthcare needs.
The study revealed that 15.4% of individuals cannot access healthcare due to financial constraints, with 16.8% for women and 13.5% for men. The highest level of unmet needs is associated with accessing dental care services for both sexes. According to multivariate analyses, the unmet need for both sexes decreases with older age and higher education level, and it is greater for those who have difficulties communicating in Turkish. By adding enabling and needs factors, the odds ratios of education decreased for men, while education became nonsignificant for women. Having chronic disease impacts unmet needs for both sexes. However, the inability to perform daily activities due to health problems was not a significant factor for men. Poorer household income increases overall unmet needs. Education is a determinant of both medical and mental care needs.
This pioneering study illuminates the multifaceted gender disparities in cost-related unmet healthcare needs across Turkiye, reflecting the intertwined issues of access influenced by a complex interplay of factors. Our findings underscore the significance of adopting an intersectional approach to address health inequalities.
未满足的医疗保健需求是一个复杂且多方面的问题，受到个人、社会经济和医疗保健系统因素的影响。本研究旨在调查影响土耳其人口中与费用相关的未满足医疗保健需求的决定因素，强调综合分析性别在获得医疗保健服务方面的差异。
本二次分析研究了 2019 年土耳其健康调查中 16976 名 15 岁及以上人群的数据。因变量包括与费用相关的未满足的医疗、牙科和规定药物以及精神服务需求。自变量被视为 Andersen 开发的用于确定卫生服务利用的三域方法的一部分。对每个性别和总体人群的任何自我感知的与费用相关的未满足需求，运行了具有倾向因素、促成因素和需求因素的 logistic 回归模型。对每个有未满足医疗保健需求的个体亚组，为两性都运行了另外六个回归模型。
研究表明，由于经济拮据，15.4%的人无法获得医疗保健，其中女性为 16.8%，男性为 13.5%。两性的未满足需求最高的是获得牙科保健服务。根据多变量分析，年龄较大和教育程度较高的人群，以及土耳其语交流困难的人群，未满足需求的比例较低。在加入促成因素和需求因素后，教育对男性的比值比降低，而对女性的教育则变得不显著。患有慢性疾病会影响两性的未满足需求。然而，由于健康问题而无法进行日常活动不是男性的一个重要因素。较差的家庭收入增加了整体未满足的需求。教育是医疗和精神保健需求的决定因素。
本开创性研究揭示了土耳其在与费用相关的未满足医疗保健需求方面存在多方面的性别差异，反映了由于各种因素相互作用而导致的获得机会的复杂问题。我们的研究结果强调了采用交叉方法解决健康不平等问题的重要性。
