Okamoto Shohei, Yamada Atsuhiro, Kobayashi Erika, Liang Jersey
Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 1730015, Japan.
Faculty of Economics, Keio University, Tokyo, Japan.
Int J Equity Health. 2025 Jan 23;24(1):28. doi: 10.1186/s12939-024-02345-7.
Ensuring equitable access to medical and long-term care (LTC) is critical to enable older people to maintain their health and well-being even after they undergo a decline in their intrinsic capacity.
We used data from five waves of the National Survey of the Japanese Elderly, conducted between 2002 and 2021, to assess gradients in access to medical care and LTC by income and education among Japanese individuals aged 60 years and above. Specifically, we assessed self-reported unmet needs for medical care and LTC, and public LTC use, and estimated the concentration indices (CI) to evaluate the degree of inequality and inequity. We standardised public LTC use by need and non-need variables. We analysed data derived from up to 1,775 person-wave observations from 1,370 individuals.
The pooled incidence across waves of forgone medical care, self-reported unmet support for activities of daily living (ADL) or instrumental ADL (IADL), and those not certified for LTC services even with ADL or IADL limitations were 4.6%, 15.5%, and 62.5%, respectively. Public LTC use demonstrated pro-higher education and pro-rich distribution, whereas the gaps decreased for need-predicted use. Based on the CI estimates, no explicit inequality was found for forgone medical care. However, we observed inequity in standardised LTC use across education, indicating pro-higher education inequality, particularly among women and those aged ≥ 80 years.
Improving the understanding of available resources and strengthening the functions of health centres and communities are required to detect the needs of citizens and facilitate their access to necessary care.
确保公平获得医疗和长期护理服务对于老年人即使在其内在能力下降后仍能保持健康和幸福至关重要。
我们使用了2002年至2021年期间进行的五次日本老年人全国调查的数据，以评估60岁及以上日本个人在获得医疗保健和长期护理服务方面按收入和教育程度划分的梯度差异。具体而言，我们评估了自我报告的医疗保健和长期护理服务未满足需求、公共长期护理服务的使用情况，并估计了集中指数（CI）以评估不平等和不公平程度。我们根据需求和非需求变量对公共长期护理服务的使用情况进行了标准化。我们分析了来自1370名个体的多达1775人次观测数据。
各轮调查中放弃医疗护理、自我报告的日常生活活动（ADL）或工具性ADL（IADL）未得到满足的支持，以及即使存在ADL或IADL限制也未获得长期护理服务认证的综合发生率分别为4.6%、15.5%和62.5%。公共长期护理服务的使用呈现出有利于高学历和高收入人群的分布，而需求预测使用方面的差距有所缩小。根据集中指数估计，放弃医疗护理方面未发现明显的不平等。然而，我们观察到标准化长期护理服务使用在教育程度方面存在不公平现象，表明存在有利于高学历人群的不平等，特别是在女性和80岁及以上人群中。
需要提高对可用资源的认识，并加强健康中心和社区的功能，以发现公民的需求并促进他们获得必要的护理。
