Abstract
Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.
Highlights
Home healthcare and medical care needsThe needs for home healthcare (HHC) is increasing due to the aim of aging in place in the era of global population aging
Based on the theories of fundamental causes of disease and feminization of poverty [16, 20], we argued that women, patients with lower income, and those who live in more rural areas may be more likely to have a higher level of medical care needs
Material and methods Data sources and samples. The data for this cross-sectional population-based study was obtained from the National Health Insurance Research Database (NHIRD) from 1997 to 2013 in Taiwan
Summary
Home healthcare and medical care needsThe needs for home healthcare (HHC) is increasing due to the aim of aging in place in the era of global population aging. Gender and medical care needs for HHC. HHC has undergone enormous growth over the last 30 years but studies about the relationships between gender and medical care needs for HHC service are inconclusive. Some studies found that women are more likely to receive HHC and report greater unmet home care needs than men [8, 9], and this gender gap increases by age [10]. In the patients who received HHC services, men have higher frequencies of medical care utilization than women among the disabled group [12] and were more likely to have multiple hospitalizations in the last 3 months of life than women in people with dementia [13]
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