Hoff R A, Rosenheck R A
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Med Care. 1998 Jul;36(7):1114-9. doi: 10.1097/00005650-199807000-00017.
As access of women to mental health services has become increasingly important, empirical research has begun to examine the determinants of mental health care utilization across gender. This article examines the effect of being an extreme minority on utilization of Department of Veterans Affairs (VA) health services by female veterans.
Data were collected on a representative national sample of veterans in 1992 as part of the National Survey of Veterans. These data included information on sociodemographic variables, military service variables, physical health and disability, and health services utilization. The authors examined whether women who used health services in 1992, and who were eligible for VA care, differed from men on the likelihood of using any VA health services and on the likelihood of use of VA outpatient and inpatient health services. In addition, we compared VA health care utilization among subgroups of veterans with physical and mental disorders, and compared self-reported reasons for choice of health care provider, across gender.
Results indicated that female veterans were less likely than male veterans to use VA health services. This difference was explained by lower utilization by women of VA outpatient services, since inpatient admission rates were the same across gender. The lower outpatient utilization was specific to women with self-reported mental disorders. Women with physical conditions did not differ from men with similar conditions in their VA outpatient utilization. Finally, men and women did not differ on their reasons for choosing VA or non-VA care.
The authors conclude that extreme gender minority status appears to affect outpatient utilization rates at the VA among women with mental disorders, perhaps because of the more personal or sensitive nature of the services involved. Further research is needed to understand why certain women may be underutilizing VA outpatient services and on the consequences of minority gender status for health service utilization, more generally.
随着女性获得心理健康服务变得日益重要，实证研究已开始考察不同性别心理健康护理利用的决定因素。本文探讨作为极端少数群体对女性退伍军人利用退伍军人事务部（VA）医疗服务的影响。
作为全国退伍军人调查的一部分，于1992年收集了具有代表性的全国退伍军人样本数据。这些数据包括社会人口统计学变量、军事服役变量、身体健康和残疾情况以及医疗服务利用情况等信息。作者考察了1992年使用医疗服务且有资格享受VA护理的女性在使用任何VA医疗服务的可能性以及使用VA门诊和住院医疗服务的可能性方面是否与男性存在差异。此外，我们比较了患有身体和精神疾病的退伍军人亚组之间的VA医疗服务利用情况，并比较了不同性别选择医疗服务提供者的自我报告原因。
结果表明，女性退伍军人使用VA医疗服务的可能性低于男性退伍军人。这种差异是由于女性对VA门诊服务的利用率较低，因为住院率在不同性别间相同。较低的门诊利用率在自我报告有精神疾病的女性中尤为明显。患有身体疾病的女性在VA门诊利用率方面与患有类似疾病的男性没有差异。最后，男性和女性在选择VA或非VA护理的原因上没有差异。
作者得出结论，极端的性别少数群体身份似乎会影响患有精神疾病的女性在VA的门诊利用率，这可能是因为所涉及服务的个人性质或敏感性更高。需要进一步研究以了解为什么某些女性可能未充分利用VA门诊服务，以及更普遍地了解少数性别身份对医疗服务利用的影响。
