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Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Policy".

Deadline for manuscript submissions: closed (31 May 2023) | Viewed by 38859

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Special Issue Editors

Prof. Dr. Jay J. Shen

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Guest Editor

Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Interests: health services research; socioeconomic disparities in access to care and outcomes; quality of care and patient safety; community engagement and comparative effectiveness research; palliative care, and substance use and mental health

Dr. Soumya Upadhyay

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Guest Editor

Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Interests: healthcare quality and patient safety; patient safety culture; healthcare finance; health information technology; cultural competency, and diversity

Dr. Betty Burston

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Guest Editor

Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
Interests: Health and healthcare disparities; health outcomes; public health prevention strategies; social health issues; unhealthy psychosocial behaviors; the role of dissent leadership in effecting positive change

Special Issue Information

Dear Colleagues,

An abundance of research now confirms a direct relationship between socioeconomic status and health outcomes. Oftentimes mitigated by unequal access to care, and patterned barriers to healthcare utilization, an urgent need exists for an expansion in knowledge of the multiple variables that links socioeconomic status to overall health outcomes. The partially answered research questions on socioeconomic inequalities are many.

1) Are differential behavioral variables most predictive of the impact of incidences of socioeconomic status upon the illness and disease and death rates across the multiple SES strata?

2) Are socioeconomic inequalities highly correlated with levels of stress across and within the various strata?

3) How do patterns of causation differ globally and what can be learned from such operational forces when the health/SES linkages are comparatively analyzed?

4) How do shifts and ruptures in socioeconomic status affect health access, utilization, and outcomes?

5) Do distal and proximal variations shape health care access, utilization, and outcomes?

6) Have biobehavioral variables been sufficiently analyzed as a pathway that leads to differential outcomes?

7) Equally important, to what degree are simulation and/or other models are best used to demonstrate indirect as well as direct effects of social determinants on health outcomes? This list is, of course, extremely abridged.

This Special Issue of Healthcare invites conceptual, qualitative, and quantitative research that advances the existing knowledge-base of the under-discussed or undiscussed areas regarding socioeconomic determinants’ impacts upon access to care, healthcare utilization, and healthcare outcomes. We also welcome methodological research that demonstrates alternative statistical modelling approaches that are predictive of individual and/or community-based disparities based on differential socioeconomic determinants. The queries presented are, of course, solely illustrative. We look forward to the inclusion of your research in this Special Issue on this very important topic.

Prof. Dr. Jay J. Shen
Dr. Soumya Upadhyay
Dr. Betty Burston
Guest Editors

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Keywords

disparity
inequality
access to care
healthcare utilization
healthcare outcomes

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Research

20 pages, 571 KiB

Open AccessArticle

Basic Health Service Delivery to Vulnerable Populations in Post-Conflict Eastern Congo: Asset Mapping

by Dieudonne Bwirire, Rik Crutzen, Rianne Letschert, Edmond Ntabe Namegabe and Nanne de Vries

Healthcare 2023, 11(20), 2778; https://doi.org/10.3390/healthcare11202778 - 20 Oct 2023

Viewed by 1355

Abstract

Populations in post-conflict settings often have increased healthcare needs, residing in settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. Assets can be described as the collective resources that individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status. This study applies an asset-based approach to explore the most optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of asset-based community development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 210 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 57 were related to local associations, 23 to land and physical environments, 43 to local institutions, 46 to individuals, 35 to economy and exchange, and only 6 to culture, history, and stories. Drawing upon the findings of the qualitative survey, community walks, and group discussions, we concluded that an important number of resources are in place for basic health service delivery. By activating existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate for identifying existing and potential resources for basic health services in a post-conflict setting. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

11 pages, 839 KiB

Open AccessArticle

Maternal Risk Factors Associated with Negative COVID-19 Outcomes and Their Relation to Socioeconomic Indicators in Brazil

by Helena Fiats Ribeiro, Maria Dalva de Barros Carvalho, Fernando Castilho Pelloso, Lander dos Santos, Marcela de Andrade Pereira Silva, Kely Paviani Stevanato, Deise Helena Pelloso Borghesan, Isaac Romani, Vlaudimir Dias Marques, Karina Maria Salvatore de Freitas, Ana Carolina Jacinto Alarcão, Constanza Pujals, Raíssa Bocchi Pedroso, Alexandrina Aparecida Maciel Cardelli and Sandra Marisa Pelloso

Healthcare 2023, 11(14), 2072; https://doi.org/10.3390/healthcare11142072 - 20 Jul 2023

Cited by 2 | Viewed by 1161

Abstract

Background: This study aimed to analyze maternal risk factors associated with negative outcomes of COVID-19 and association with socioeconomic indicators in Brazil. Methods: A cross-sectional study, with data from the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) of pregnant women with COVID-19 and cases of hospitalization and death. For the analysis of risk factors and outcomes, the multiple logistic regression method was used. Results: Pregnant women who had some risk factor represented 47.04%. The chance of death was 2.48 times greater when there was a risk factor, 1.55 for ICU admission and 1.43 for use of ventilatory support. The percentage of cure was 79.64%, 15.46% without any negative outcome, 4.65% death and 0.26% death from other causes. Pregnant women who did not take the vaccine represented 30.08%, 16.74% took it and 53.18% were not specified. The variables HDI, illiteracy, per capita income and urbanization did not influence the cases of COVID-19. Conclusions: Factors such as age, obesity, asthma and pregnancy were responsible for the increase in hospitalizations, respiratory complications and death. Vaccination reduced the risk of negative outcomes by 50%. There were no correlations between socioeconomic indicators and the negative outcomes of COVID-19 in pregnant women. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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14 pages, 948 KiB

Open AccessArticle

Social Experiences, Discrimination, and Violence among Men Who Have Sex with Men in a Northern Brazilian Capital

by Alexandre Mansuê Ferreira Carneiro, Yan Corrêa Rodrigues, Maria Fani Dolabela, Luana Nepomuceno Godim Costa Lima, Ricardo José de Paula Souza Guimarães, Carl Kendall, Ligia Regina Franco Sansigolo Kerr and Karla Valéria Batista Lima

Healthcare 2023, 11(7), 964; https://doi.org/10.3390/healthcare11070964 - 28 Mar 2023

Viewed by 1741

Abstract

Men who have sex with men who suffer stigmatization and discrimination become more fragile in facing life’s problems, such as the search for treatment in health services. In the present study, the social aspects related to discrimination and violence among men who have sex with men in Belém, Pará, are evaluated. Data were obtained by applying the respondent-driven sampling method to recruit 349 participants aged 18 years or older and who reported having had at least one sexual relationship with a man in the last 12 months. Data were collected from June to December 2016 in a semi-structured interview. Five seeds were initially recruited who applied RDS. The vast majority were between 18 and 35 years old, had completed elementary school but not high school, and were of mixed race. Almost a third lived in peripheral neighborhoods and were employed/self-employed. Additionally, most participants reported having suffered aggression/discrimination, more often in religious contexts, with family or in health services. The findings reported here may contribute to the development of public policies aimed at this population and indicate the need for new strategies to combat sexually transmitted infections, stigma, and discrimination suffered by this population. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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12 pages, 971 KiB

Open AccessArticle

Socioeconomic Status and Quality of Life: An Assessment of the Mediating Effect of Social Capital

by Jonathan Aseye Nutakor, Lulin Zhou, Ebenezer Larnyo, Stephen Addai-Danso and Debashree Tripura

Healthcare 2023, 11(5), 749; https://doi.org/10.3390/healthcare11050749 - 3 Mar 2023

Cited by 24 | Viewed by 7667

Abstract

Socioeconomic status has been found to be a significant predictor of quality of life, with individuals of higher socioeconomic status reporting better quality of life. However, social capital may play a mediating role in this relationship. This study highlights the need for further research on the role of social capital in the relationship between socioeconomic status and quality of life, and the potential implications for policies aimed at reducing health and social inequalities. The study used a cross-sectional design with 1792 adults 18 and older from Wave 2 of the Study of Global AGEing and Adult Health. We employed a mediation analysis to investigate the relationship between socioeconomic status, social capital, and quality of life. The results showed that socioeconomic status was a strong predictor of social capital and quality of life. In addition to this, there was a positive correlation between social capital and quality of life. We found social capital to be a significant mechanism by which adults’ socioeconomic status influences their quality of life. It is crucial to invest in social infrastructure, encourage social cohesiveness, and decrease social inequities due to the significance of social capital in the connection between socioeconomic status and quality of life. To improve quality of life, policymakers and practitioners might concentrate on creating and fostering social networks and connections in communities, encouraging social capital among people, and ensuring fair access to resources and opportunities. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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14 pages, 296 KiB

Open AccessArticle

Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic

by Edward K. Adinkrah, Sharon Cobb and Mohsen Bazargan

Healthcare 2023, 11(4), 595; https://doi.org/10.3390/healthcare11040595 - 16 Feb 2023

Cited by 4 | Viewed by 2033

Abstract

Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

12 pages, 503 KiB

Open AccessArticle

Factors Associated with Tuberculosis Outcome in a Hyperendemic City in the North of Brazil

by Gabriel Fazzi Costa, Juliana Conceição Dias Garcez, Weber Marcos, Ana Lúcia da Silva Ferreira, Jorge Alberto Azevedo Andrade, Yan Corrêa Rodrigues, Luana Nepomuceno Gondim Costa Lima, Emilyn Costa Conceição and Karla Valéria Batista Lima

Healthcare 2023, 11(4), 508; https://doi.org/10.3390/healthcare11040508 - 9 Feb 2023

Cited by 8 | Viewed by 2114

Abstract

Ananindeua city, State of Pará, North of Brazil, is a hyperendemic area for tuberculosis (TB), with a cure rate below the recommendation by the Brazilian Ministry of Health. We aimed to describe: (I) the TB incidence coefficient of Ananindeua municipality comparatively against Brazilian data; (II) TB treatment outcomes; (III) to compare the socioeconomic and epidemiological characteristics of abandonment versus cure outcome; and (IV) to evaluate the risk factors associated with TB treatment abandonment in Ananindeua city, from 2017 to 2021. This is a retrospective, descriptive, and cross-sectional epidemiological study which used secondary TB entries. Data were analyzed by linear regression, descriptive statistics, and associations were made using the Chi-square test and G-test, followed by univariate and multivariate logistic regression analyses. Cure rates ranged from 28.7% to 70.1%, abandonment between 7.3% and 11.8%, deaths from the disease ranged from 0% to 1.6%, and drug-resistant tuberculosis (TB-DR) rates had frequencies from 0% to 0.9%. Patient transfer rates to other municipalities were between 4.9% and 12.5%. The multivariate analysis showed that alcohol is almost 2 times more likely to lead an individual to abandon treatment and use of illicit drugs was almost 3 times more likely. Individuals between 20 and 59 years of age were also more likely to abandon treatment almost twice as often. Finally, data obtained in the present report is of great relevance to strengthen epidemiological surveillance and minimize possible discrepancies between the information systems and the reality of public health in high endemicity areas. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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10 pages, 1391 KiB

Open AccessArticle

Association between Socioeconomic Status and Healthcare Utilization for Children with Allergic Diseases: Korean National Health and Nutritional Examination Survey (2015–2019)

by Jeoungmi Kim, Bomgyeol Kim, Do Hee Kim, Yejin Kim and Vasuki Rajaguru

Healthcare 2023, 11(4), 492; https://doi.org/10.3390/healthcare11040492 - 8 Feb 2023

Cited by 6 | Viewed by 2044

Abstract

This study aimed to investigate the association between socioeconomic status (SES) and healthcare utilization by children with allergic diseases. We determined SES based on parental occupation and household income. A cross-sectional study was conducted using the Korean National Health and Nutritional Examination Survey (KNHANES) between 2015 and 2019 with participants who were under 18 years of age. The presence of allergic conditions was determined by a self-reported survey of parental response and healthcare utilization data (such as inpatient and outpatient visits). Moreover, we categorized SES into four quantiles (Q1–Q4) based on household income per annum. Then, the data were analyzed using chi-square tests and multivariate logistic regression analysis with confidence intervals (CIs) of 95%, and p < 0.05 was considered significant. A total of 3250 participants were involved in this study. The percentage of allergic diseases was 67.9% for allergic asthma and 32.1% for atopic dermatitis. It was found that the participants who were over 13 years old had atopic dermatitis and were more likely to visit the hospital than younger children. Additionally, the highest SES group in Q4 demonstrated higher healthcare utilization (OR = 1.58; 95% CI, 1.14–1.76) than other SES groups. Our study reveals that parental socioeconomic characteristics are related to the use of healthcare services for children with allergic disorders in Korea. These results highlight the need for public health actions and research to overcome the SES gap among children with allergic diseases. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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10 pages, 265 KiB

Open AccessArticle

Epidemiological/Disease and Economic Burdens of Cervical Cancer in 2010–2014: Are Younger Women at Risk?

by Chuhao Xi, Jay J. Shen, Betty Burston, Soumya Upadhyay and Shoujun Zhou

Healthcare 2023, 11(1), 144; https://doi.org/10.3390/healthcare11010144 - 3 Jan 2023

Cited by 8 | Viewed by 1867

Abstract

Objective: Cervical cancer is an important factor threatening women’s health in China. This study examined the epidemiological and economic burden of cervical cancer among the medically insured population, which could provide data support for government departments to formulate policies. Methods: All new cases of cervical cancer under the Urban Employee Basic Medical Insurance (UEBMI) plan in a provincial capital city in eastern China from 2010 to 2014 were collected. The Cox proportional hazard model was used to analyze the factors affecting the survival rates for cervical cancer. Outpatient and hospitalization expenses were used to assess the direct economic burden, and the Potential Years of Life Loss (PYLL) and potential economic loss were calculated by the direct method to assess indirect burden. Results: During the observation period, there were 1115 new cases and 137 deaths. The incidence rate was 14.85/100,000 person years, the mortality was 1.82/100,000 person years, and the five-year survival rate was 75.3%. The age of onset was mainly concentrated in the 30–59 age group (82.9%) and the tendency was towards younger populations. The age of onset (HR = 1.037, 95% CI = 1.024–1.051), the frequency of hospitalization services (HR = 1.085, 95% CI = 1.061–1.109), and the average length of stay (ALOS) (HR = 1.020, 95% CI = 1.005–1.051) were the related factors affecting overall survival. Among the direct economic burden, the average outpatient cost was $4314, and the average hospitalization cost was $12,007. The average outpatient and hospitalization costs within 12 months after onset were $2871 and $8963, respectively. As for indirect burden, the average Potential Years of Life Loss (PYLL) was 27.95 years, and the average potential economic loss was $95,200. Conclusions: The epidemiological and economic burden reported in the study was at a high level, and the onset age of cervical patients gradually became younger. The age of onset, the frequency of hospitalization services and the ALOS of cervical cancer patients should be given greater attention. Policymakers and researchers should focus on the trend of younger onset age of cervical cancer and the survival situation within 12 months after onset. Early intervention for cervical cancer patients, particularly younger women, may help reduce the burden of cervical cancer. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

15 pages, 302 KiB

Open AccessArticle

Study on the Socio-Economic Impact of Cancer Disease on Cancer Patients and Their Relatives

by Alberto Garcia Martin, Eduardo J. Fernandez Rodriguez, Celia Sanchez Gomez and Maria I. Rihuete Galve

Healthcare 2022, 10(12), 2370; https://doi.org/10.3390/healthcare10122370 - 25 Nov 2022

Cited by 4 | Viewed by 3114

Abstract

Background: Cancer is one of the most relevant social and health problems in the world. The disease entails additional costs for cancer patients and their families that are not covered by the public part of our welfare state, and which they assume themselves simply because they are ill. The main objective of this study is to identify and analyse the additional cost and socioeconomic impact of cancer disease on patients diagnosed with cancer disease and their families. Methods: Descriptive cross-sectional randomised observational epidemiological study without replacement with prevalence of cancer disease in the study base, carried out in the Medical Oncology Service of the Complejo Asistencial Universitario de Salamanca (CAUSA), Spain. Results: The study variable has been the additional cost of the cancer disease for cancer patients and their families that is not covered by our autonomous health system. Conclusions: Cancer disease entails an additional cost for the patient and family; more specifically, for 55% of the patients in the study sample, the diagnosis of cancer represents extra expenditure of between 8.38–9.67% of their annual income. Furthermore, the disability and dependence of patients does not represent an additional cost due to their levels of functionality, but it can have repercussions on the future cost of the evolution of the disease, in addition to the fact of having cancer. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

13 pages, 1784 KiB

Open AccessArticle

Spatial and Socioeconomic Inequalities in Accessibility to Healthcare Services in South Korea

by Sangwan Lee

Healthcare 2022, 10(10), 2049; https://doi.org/10.3390/healthcare10102049 - 17 Oct 2022

Cited by 18 | Viewed by 3221

Abstract

This study explored questions of (1) whether certain areas of South Korea experienced inequal accessibility to public health centers, private hospitals/clinics, and general hospitals by car and public transportation using gaussian mixture models (GMM) and (2) whether socially disadvantaged socioeconomic groups faced disproportionate burdens on accessibility to the multi-tier healthcare services employing ordinary least square regression models (OLS). This study used nationwide accessibility indicators in South Korea measured by Korea Transport Institute in 2019. The main findings were as follows: First, the results of the GMM indicate that the degree of accessibility to healthcare services was significantly lower in rural, mountainous, and seaside locations compared to metropolitan areas. Second, there was more considerable inequality in public transportation accessibility than car accessibility. Third, the findings of the OLS reveal a significant relationship between accessibility indicators and socioeconomic variables, such as age, gender, disability, and residential location, which indicates socioeconomic inequality in accessibility in South Korea. This study contributes to shedding light on understanding the spatial and socioeconomic inequality in accessibility across the nation and offering policy implications. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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11 pages, 937 KiB

Open AccessArticle

Trends in the Utilization of Human Papillomavirus Vaccines and the Incidence of Malignant Cervical Cancer in Women and Teenagers: A Secondary Analysis

by Myah Luna and Soumya Upadhyay

Healthcare 2022, 10(7), 1211; https://doi.org/10.3390/healthcare10071211 - 28 Jun 2022

Cited by 1 | Viewed by 1759

Abstract

Background: Human papillomavirus (HPV) is a sexually transmitted infection, and HPV types 16 and 18 are responsible for approximately 66% of all U.S. cervical cancer cases in women. The quadrivalent HPV vaccine was licensed in mid-2006, and it was designed to target and protect against HPV types 6, 11, 16, and 18. The aim of this study is to examine the utilization rate of the HPV vaccine, and the trends and incidence rate of malignant cervical cancer across the United States. Methods: This study utilized data from Surveillance, Epidemiology, and End Results (SEER) and the National Immunization Survey’s (NIS) teenage datasets across select years. For the SEER survey, the modification for confidence intervals by Tiwari et al., 2006, was utilized to obtain the incidence rate per 100,000, so that it could be age-adjusted for the 2000 U.S. standard population, as noted in the data provided by the U.S. Census. The dates examined started in the year 2000 and ended in 2017. For the NIS-Teen survey, the public-use data file was used, and a point estimate (%), with a 95% confidence interval, was performed to examine the trends in HPV vaccine utilization across the U.S. adolescent female population from the years 2007 to 2019. Results: This study found that the rate of diagnosis had been falling over the nearly two decades examined in this study. Implications: This study would support current efforts to encourage the utilization of HPV vaccines that are currently in the vaccination schedule rotation, and to illustrate the importance of completing all doses of the three-step series. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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8 pages, 483 KiB

Open AccessArticle

Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES)

by Yung-Taek Ouh, Kyung-Jin Min, Sanghoon Lee, Jin-Hwa Hong, Jae Yun Song, Jae-Kwan Lee and Nak Woo Lee

Healthcare 2022, 10(6), 997; https://doi.org/10.3390/healthcare10060997 - 27 May 2022

Cited by 4 | Viewed by 2137

Abstract

Hysterectomy remains a frequent gynecologic surgery, although its rates have been decreasing. The aim of this study was to investigate whether socioeconomic status affected the risk of hysterectomy in Korean women. This prospective cohort study used epidemiologic data from 2001 to 2016, from the Korean Genomic and Epidemiology Study (KoGES). Multivariate logistic regression analyses were performed to estimate the association between household income or education level and hysterectomy. Among 5272 Korean women aged 40–69 years, 720 who had a hysterectomy and 4552 controls were selected. Variable factors were adjusted using logistic regression analysis (adjusted model). Adjusted odds ratios (aORs) for insurance type and hysterectomy were not statistically significant. The aOR was 1.479 (95% confidence interval (CI): 1.018–2.146, p < 0.05) for women with education of high school or lower compared to college or higher. Women whose monthly household income was <KRW 4,000,000 had a higher risk of undergoing hysterectomy than women whose monthly household income was ≥KRW 4,000,000 (aOR: 2.193, 95% CI: 1.639–2.933, p < 0.001). Overall, the present study elucidated that lower socioeconomic status could increase the incidence of hysterectomy. Our results indicate that the implementation of stratified preventive strategies for uterine disease in those with low education and low income could be beneficial. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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11 pages, 257 KiB

Open AccessArticle

How Different Is the Annual Physical Examination of Older Migrants than That of Older Nonmigrants? A Coarsened Exact Matching Study from China

by Wanyue Dong, Jianmin Gao, Yue Wu, Chi Shen and Ruhai Bai

Healthcare 2022, 10(5), 815; https://doi.org/10.3390/healthcare10050815 - 27 Apr 2022

Cited by 3 | Viewed by 1774

Abstract

It has become a top priority to ensure equal rights for older migrants in China. This study aims to explore how different the annual physical examination of older migrants is compared to that of older nonmigrants in China by using a coarsened exact matching method, and to explore the factors affecting annual physical examination among older migrants in China. Data were drawn from the China Migrants Dynamic Survey 2015 and China Health and Retirement Longitudinal Survey 2015. The coarsened exact matching method was used to analyse the difference in the annual physical examination of older migrants and nonmigrants. A logistic regression was used to analyse the factors affecting annual physical examination among older migrants. The annual physical examination of older migrants was 35.6%, which was significantly lower than that of older nonmigrants after matching (Odds ratios = 0.91, p < 0.05). It was affected by education, employment, hukou, household economic status, health, health insurance, main source of income, type of migration, range of migration, years of migration, having health records in local community and number of local friends among older migrants in China. Older migrants adopted negative strategies in annual physical examination compared to older nonmigrants. Active strategies should be made to improve the equity of annual physical examination for older migrants in China. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

8 pages, 460 KiB

Open AccessArticle

Comparison between the Aged Care Facilities Provided by the Long-Term Care Insurance (LTCI) and the Nursing Hospitals of the National Health Insurance (NHI) for Elderly Care in South Korea

by Hyeri Shin

Healthcare 2022, 10(5), 779; https://doi.org/10.3390/healthcare10050779 - 22 Apr 2022

Cited by 1 | Viewed by 2019

Abstract

Long-term Care Insurance (LTCI) was created for the elderly, to provide various types of medical and care services, along with the National Health Insurance (NHI). However, the elderly must choose one of these systems, which leads to some of them being unable to receive services and care/medical care based on their needs, because the LTCI only provides limited services, regardless of the needs of the elderly. In order to establish the best solution between the LTCI and NHI, I conducted a utilization effect analysis; using the difference in difference (DID) and difference in difference in difference (DDD) methods with National Health Insurance Services-senior (NHIS-senior) cohort data from 2008 to 2013. The results of the study confirmed that medical expenses are significantly reduced for LTCI users (B = −3.176, p ≤ 0.001). Furthermore, when the services meet the older person’s needs, the overall medical expenses are significantly reduced (B = −1.034, p = 0.05). These results clearly show that the LTCI is much more suitable for those who need care services. To provide services that more efficiently fulfil their needs, and for better population coverage from the two different systems (the NHI and the LTCI), collaborative work, such as a linkage system, is required. Full article

(This article belongs to the Special Issue Socioeconomic Inequalities in Access to Care, Outcomes, and Healthcare Utilization)

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