Abstract
Aim:We examined how, where an overall population is covered by universal health insurance, characteristics of disadvantaged populations interact to influence inequality in primary and secondary medical care utilization.Subject and Methods:Disadvantaged populations, the focus of the study, were defined as populations who have lower socio-economic status (SES), who are elderly and/or reside in a peripheral area. Data from the 2009 Israeli National Health Survey were analysed using log-linear models to estimate utilization of medical care.Results:The main findings were: a) pro-poor utilization of primary medical care among elderly populations, with higher odds ratios for low SES populations in the periphery; (b) lack of interaction between SES and primary medical care utilization among younger populations, between SES and secondary medical care utilization among the elderly and pro-rich utilization of secondary medical care among younger populations who did not regularly visit general practitioners (GP); (c) the odds ratios of secondary medical care utilization increased as SES decreased for both elderly and younger populations who also regularly visited a GP.Conclusion:Potential policy implications for disadvantaged populations, regarding possible inequality in primary and secondary medical care utilization, can be drawn using log-linear model analysis of interactions among characteristics (SES, age, location) of disadvantaged populations.
Highlights
Disadvantaged populations are defined as those with a relative deprivation of social and financial resources and/or occupational prestige
The main findings were: a) pro-poor utilization of primary medical care among elderly populations, with higher odds ratios for low socio-economic status (SES) populations in the periphery; (b) lack of interaction between SES and primary medical care utilization among younger populations, between SES and secondary medical care utilization among the elderly and pro-rich utilization of secondary medical care among younger populations who did not regularly visit general practitioners (GP); (c) the odds ratios of secondary medical care utilization increased as SES decreased for both elderly and younger populations who regularly visited a GP
After the survey data was categorized (Tables 1–3, Figures 1, 2), and starting from the initial saturated form (1), the log-linear models were estimated with SPSS (IBM SPSS Statistics 20)
Summary
Disadvantaged populations are defined as those with a relative deprivation of social and financial resources and/or occupational prestige. For these populations, we can often see a violation of the principle of equity in health care, defined as “equal utilization for equal need” (Aday & Andersen, 1981; Whitehead, 1992). The use of health care can be considerably disadvantaged by the travel distances (Jordan et al, 2004). The purpose of this study was to examine how the aforementioned interactions among characteristics of disadvantaged populations influence primary and secondary medical care utilization, under the assumption that the overall population is covered by universal health insurance, as required by Israeli law A number of recent empirical studies have examined the effects of various factors and their interactions characterizing inequality in medical care utilization: accessibility within the periphery (Mangano, 2010), SES (Kim et al, 2012), insurance status (Wendt, 2009), age, gender, income, education level (Hansen et al, 2012), and regional variation (Masseria & Giannoni, 2010).
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