Abstract
Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike’s information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01–2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.
Highlights
One of the highest priorities for health professionals and policy makers around the world is the provision of adequate health care resources [1, 2]
The indices of 2SFCA, enhanced 2SFCA (E2SFCA) with slow decay, and E2SFCA with quick decay were higher for participants
According to a theoretical model by the Institute of Medicine’s Committee on Monitoring Access to Personal Health Care Services, personal factors, such as income and education, financial factors, such as public support and insurance coverage, and structural factors, such as availability and transportation, all contribute to service utilization, which correlates with health status [24, 25]
Summary
One of the highest priorities for health professionals and policy makers around the world is the provision of adequate health care resources [1, 2]. Some studies of mammography screening, the subject relatively frequently investigated, have found that low geographic accessibility to facilities was associated with low participation rates [8, 9, 12, 13], whereas others found no association or even an inverse association [10, 11, 14]. Socioeconomic status, such as income and education level, has been recognized as another factor in the utilization of health care services. We found decreased utilization of outpatient care among people with lower income in Japan [18]
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