Factors Affecting Health Care Utilization Research Articles

Healthcare Utilization and Its Correlates in Comorbid Type 2 Diabetes Mellitus and Generalized Anxiety Disorder.

This study investigated the healthcare utilization and medical expenditure of type 2 diabetes mellitus (T2DM) patients with generalized anxiety disorder (GAD) and identified the associated factors. The healthcare utilization and expenditure of T2DM patients with (case group) and without (control group) GAD between 2002 and 2013 were examined using the population-based Taiwan National Health Insurance Research Database. Healthcare utilization included outpatient visits and hospitalization; health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, nonpsychiatric healthcare utilization and medical expenditure were distinguished from total healthcare utilization and medical expenditure. The average healthcare utilization, including outpatient visits and hospitalization, was significantly higher for the case group than for the control group (total and nonpsychiatric). The results regarding differences in average outpatient expenditure (total and nonpsychiatric), inpatient expenditure (total and nonpsychiatric), and total expenditure (total and nonpsychiatric) between the case and control groups are inconsistent. Sex, age, income, comorbidities/complications, and the diabetes mellitus complication severity index were significantly associated with outpatient visits, medical expenditure, and hospitalization in the case group (total and nonpsychiatric). Greater knowledge of factors affecting healthcare utilization and expenditure in comorbid individuals may help healthcare providers intervene to improve patient management and possibly reduce the healthcare burden in the future.

The Mediating Role of Digital Competence in the Associations Between the Factors Affecting Healthcare Utilization and Access to Care.

Objectives: To examine with a population-based longitudinal survey design whether poor health, longstanding activity limitation, impaired cognitive functioning, mental distress, or loneliness predict poor access to healthcare and whether digital competence mediates these associations. Methods: The data were from the longitudinal FinHealth -survey gathered in Finland in 2017 and 2020 including 3,771 respondents (57.1% women). Linear regression analyses were used to examine the associations of factors affecting healthcare utilization with access to care adjusted for age, sex, and education. Counterfactual causal mediation framework was used to examine the mediating role of digital competence in the relationships among these factors and access to healthcare. Results: Factors affecting healthcare utilization were associated with poor access to care and these associations were partly mediated by low digital competence. Low digital competence mediated 12%, 9% and 8%, of the associations of impaired cognitive functioning, longstanding activity limitation, and loneliness with poor access to care, respectively. Conclusion: According to our results, one way to improve the access to healthcare among vulnerable groups could be to improve their digital competence.

Socioeconomic Inequality and Associated Factors Affecting Health Care Utilization among the Elderly: Evidence from the China Health and Retirement Longitudinal Study

Background: Elderly population is particularly vulnerable to socioeconomic disparities. This study assessed inequalities in health care utilization among the elderly in China and identified contributing factors. Methods: This study used data from the 2018 China Health and Retirement Longitudinal Study survey. A non-linear probit regression model based on the Andersen Health Care Utilization Model was used to identify determinants of health care utilization among the elderly. The concentration index (CI) and the decomposition of the CI were calculated to evaluate inequalities in health care utilization among the elderly and identify related contributors. Results: The CI for actual and standardized outpatient visits was 0.0889 and 0.0945, respectively, and the corresponding values for inpatient service utilization were 0.1134 and 0.1176, respectively. Factors that contributed to greater inequalities in the utilization of outpatient and inpatient service included income (73.68% for outpatient service; 85.20% for inpatient service), Urban Employee Basic Medical Insurance (UEBMI) (40.75% for outpatient service; 32.03% for inpatient service) and non-agricultural Hukou status (12.63% for outpatient service; 18.73% for inpatient service). New Rural Cooperative Medical Scheme (NRCMS) (−34.30% for outpatient service; −33.18% for inpatient service) and poor health status (−7.36% for outpatient service; −8.30% for inpatient service) reduced inequalities in outpatient and inpatient utilization. Conclusions: This study found that a key contributor to these inequalities was income, followed by UEBMI coverage. Meanwhile, health care coverage through NRCMS was associated with fewer disparities in health care utilization.

Healthcare Behavior, Utilization and Associated Factors in the Rural Areas of Khyber Pakhtunkhwa-Pakistan

Health care seeking behavior, utilization and its associated are important for the economic development of a country. However, the subject has not caught enough attention in Pakistan. Therefore, current research study is implemented in the rural areas of Khyber Pakhtunkhwa Pakistan. The study used mixed method approach and data were collected from 278 respondents and 20 key informants. Data were analyzed through descriptive statistics and thematic analysis. The use of formal health facilities was found a bit high (56%) as compared to the informal healthcare facilities (44%). The private healthcare utilization was high as compared to government healthcare facilities. Gender, education, income, and location were found as the important factors affecting healthcare utilization in the study area. It is concluded that although rural people tend to utilize formal healthcare, but still the informal system is active. Therefore, the government healthcare system must emphasize on quality and timely service provision.

Factors Associated with Chronic Disease and Health Care Utilization Among Young Adults in South Korea.

Hypertension, diabetes, and hyperlipidemia have become prevalent in young adults. Health care utilization is a key factor in managing early onset chronic diseases. This study aimed to examine the factors affecting health care utilization among young South Korean adults with a single chronic disease. From the Korea Health Panel Survey data collected between 2014 and 2017, young adults who were 30-49 years old and diagnosed with a single chronic condition (hypertension, diabetes, or hyperlipidemia) were included in this study (n = 993). The factors affecting health care utilization were analyzed through multiple logistic regression. The health care utilization rate of the 40-49 and 30-39-year age groups was 84.2% and 71.1%, respectively, and it was significantly higher in the healthy behavior group, who had no smoking and drinking habits and joined in physical activities. Among the chronic diseases, hyperlipidemia obtained the lowest health care utilization rate (62.8%). From the multiple logistic regression analysis, medication intake was likely to increase in the older, unemployed, and healthy behavior groups. Patients with hypertension and diabetes were more likely to use health care services than those with hyperlipidemia. Given the rising prevalence of chronic diseases among young adults, these findings may be helpful in implementing new public health approaches for this type of population by encouraging proper health care utilization.

Factors affecting health care utilization of immigrants living in North of Turkey

PurposeThis paper aims to determine factors affecting health-care utilization of immigrants living in North of Turkey and make a case assessment about this factors and general health status of immigrants.Design/methodology/approachThis study was conducted in accordance with the principles of descriptive research. The data of the study were collected by using questionnaire consisting of 33 questions that include socio-demographic specifications, use of health services and health perception level.FindingsThis study was conducted with 360 immigrants. Participants, of which 61.9% were female. Immigrants who are young, female, married, have low education, have chronic illnesses, and have been in hospital before, have a better use of health services.Originality/valueImmigration experiences of immigrants and their lack of equal opportunities to access health services in the community lead them to use health services at a low level.

Factors Affecting Healthcare Utilization among Patients with Single and Multiple Chronic Diseases.

Background:We aimed to investigate the factors affecting healthcare utilization among patients with single and multiple chronic diseases using the Andersen healthcare utilization model.Methods:We used a combination of the data from the sixth and seventh Korea National Health and Nutrition Survey (2014–2016). The study population was 3,901 patients with single chronic disease and 1,829 patients with multiple chronic diseases as defined by the WHO. Participants were aged 19 yr or older. Multiple regression analysis was employed using the Andersen model to identify factors affecting healthcare utilization (inpatient and outpatient).Results:According to the Andersen model (comprising predisposing, enabling, and need factors and health behaviors), the factors that increased outpatients with single chronic disease were female, being aged 65 yr or older, having basic livelihood security benefit, immobility, and poor subjective health status. Factors that increased inpatients with single chronic disease were being aged under 65, having private insurance, immobility, poor subjective health status, and nondrinking. Moreover, factors that increased outpatients and inpatients with multiple chronic diseases were female, being aged under 65, immobility, and poor subjective health status and immobility, poor subjective health status, nondrinking, and not engaging in physical activity, respectively.Conclusion:We identified factors affecting outpatient and inpatient care utilization among patients with single and multiple chronic diseases, using the Andersen healthcare utilization model. The findings can be used as foundational data to develop preventive and management strategies in healthcare utilization among patients with single and multiple chronic diseases.

Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009–2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women’s selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.

Gender differential in health care utilisation in India

ObjectiveChoices in healthcare utilization are affected by a variety of factors related to both individuals and healthcare. There are many factors affecting health care utilization including physical, socio-economic, cultural, and political factors. One of the most critical factors that is affecting the health care utilization is gender differential. The objective is to assess the gender differential in health care utilization and the gender differential in health seeking behaviour for selected chronic diseases among tobacco and alcohol users in India. MethodsThe study involves Study on global AGEing and Adult Health (SAGE) WAVE I data source for analysis. The method consists of bivariate analysis and multivariate regression. The diseases have been categorised on the basis of alcohol and tobacco consumption. ResultsThe study found that males and females both are preferring private hospital over pubic hospital for inpatient as well as outpatient care. Males are more satisfied than females with the quality of care they received in the hospital. One of the important findings of the study is that men are covering more distance to reach hospital than women implies that women are not allowed to go faraway for their treatment. ConclusionTo tackle the gender related discrimination in health care utilization and bring in the equity, it is essential to incorporate more women friendly measures. Women empowerment and their involvement in decision making power is imperative since these are the vital components of equity in health care services.

The Effect of Health Literacy and Self-care Performance on Health Care Utilization of Medicaid Elderly

Purpose: The purpose of this study was to examine the effect of health literacy and self-care performance on health care utilization of medicaid elderly. Methods: A total of 203 medicaid elderly over 65 and living in B-metropolitan city were interviewed. Data were analyzed with descriptive statistics, t-test, ANOVA, Pearson''s correlation coefficients and Hierarchical Multiple regression. Results: The average score of the health literacy was 7.88±2.84 out of 12. The average score of self-care was 3.26±0.77 points on the 5 point scale. The frequency of health care utilization by the subjects was 6.65±5.25 a month. The health literacy and self-care performance showed a statistically significant positive correlation. The health literacy and self-care performance showed a statistically significant negative correlation with health care utilization. The factors affecting health care utilization of the subjects were self-care performance, health literacy, and religion, and the explanatory power was 25%. Conclusion: The results indicate that the self-care performance, health literacy, religion are significant factors of health care utilization in medicaid elderly. Therefore, it is necessary to develop strategies to improve their self-care performance and health literacy for reasonable health care utilization. Also, it is necessary to provide the elderly with correct information about medical use from accessible religious institutions, senior community center, and welfare centers.

Assessment of Neonatal Mortality in Women Who Gave Birth Recently: A Community Based Cross Sectional Study in Lume District of Oromia Region, Eastern Ethiopia

Introduction: Childhood mortality often used as a specific health indicator where child health programs were given low attention; especially neonatal health lacks adequate information in the study setup. This study aimed to assess neonatal mortality and factors affecting health care utilization. Methods: A cross sectional study design was employed in Lume District using Multistage sampling technique. Five rural kebele (sub unit of administration) were selected using simple random sampling and systematic random sampling technique to select study population. Structured questionnaire used to collect data and analyzed by SPSS version 20. Result: Nineteen neonatal death per one thousand live birth happened. Mothers who live in urban were two times sought health institution for delivery than rural mothers [AOR=1.9, 95% CI: (1.1, 4.0)]. Merchant mothers were three times more likely to seek professional help than daily laborer [AOR=3.0, 95% CI: (1.1, 14.5). Mothers who road was accessible were 2.8 times more likely to seek health institution for their neonate than non-road accessible mother [AOR=2.8, 95% CI: (1.2, 6.4). Neonatal sickness and neonatal death were negatively associated with mothers seeking health institution [AOR=0.02, 95% CI: (0.1, .02) and [AOR=0.07, 95% CI: (.01, .8) respectively. Conclusion and recommendation: In this study it is learnt that neonatal mortality is low and institutional delivery was high. Road accessibility, residence, occupation of the mother, neonatal sickness, neonatal death and postnatal care were significantly associated with utilization of mother’s modern health institution for last delivery.

An Econometric Analysis Of Health Care Utilization In Kenya

Background: Increasing access to health care has been a policy concern for many governments, Kenya included. The Kenyan government introduced and implemented a number of initiatives in a bid to address the healthcare utilization challenge. These initiatives include 10/20 policy, exemptions for user fees for some specific health services (treatment of children less than five years, maternity services in dispensaries and health centers, Tuberculosis treatment in public health facilities), and increase in the number of health facilities and health workforce. These initiatives notwithstanding, healthcare utilization in Kenya remains a challenge. The Kenya Household Health Expenditure and Utilization Survey of 2007 found that 17 percent of those who needed health care services could not access the services from both government and private health facilities largely due to financial constraints. This paper employed econometric analysis to examine what could be constraining health care utilization in Kenya despite all the efforts employed. Methods: Using the 2007 Kenya Household Health Expenditures and Utilization Survey (KHHEUS) data (n = 8414), this paper investigates the factors that affect health care utilization in Kenya by estimating a count data negative binomial model. The model was also applied to public and private health facilities to better understand the specificities of poverty in these two facility types. Common estimation problems of endogeneity, heterogeneity, multicollinearity and heteroskedasticity are addressed. Findings: The econometric analysis reveals that out-of-pocket expenditures, waiting time, distance, household size, income, chronic illness area of residence and working status of the household head are significant factors affecting health care utilization in Kenya. While income and distance are significant factors affecting public health care utilization they are not significant in explaining healthcare utilization in private facilities. In addition, working status of the household head, insurance cover and education are significant in explaining private and not public health care utilization. A striking finding is the positive relationship between distance and health care utilization implying that people will travel long distances to obtain treatment. This is perhaps associated with expectations of higher quality of care at far away higher level facilities, especially in rural areas. Conclusion: The paper confirms the existing evidence of the negative effects of Out-of-Pocket (OOP) expenditures and other determinants of health care utilization. With a better understanding of why people use or do not use health services, health care organizations can seek to improve the quality of human life. The bypassing of health facilities for higher level far away facilities implies that it is not so much about availing health facilities, but the quality of the services offered in those facilities. The government should therefore assure quality to increase utilization of the lower level facilities, especially in the rural areas.

Factors Affecting Health Care Utilization in OEF/OIF Veterans: The Impact of PTSD and Pain

Returning Operation Enduring Freedom and Operation Iraqi Freedom veterans are at a high risk for physical and mental health symptoms including pain (90%) and post-traumatic stress disorder (PTSD) (58%). These often present concurrently and result in many health problems, functional impairments, and overall poor rehabilitation. To address postdeployment health, effective and efficient allocation of health care resources is needed. Retrospective study of 144 veterans who completed a second-level screening in the Polytrauma clinic. Veterans completed the PTSD Checklist-Civilian Version. Their pain rating and health care utilization (sum of visits during 12 months, categorized as medical or mental health) was extracted through chart review. The majority of veterans reported significant PTSD (72%) and pain (87%) symptoms; 45% received adequate mental health treatment, defined as ≥8 sessions in 12 months. PTSD and the interaction with pain predicted medical utilization; at high pain levels veterans' PTSD severity predicted utilization. PTSD alone predicted mental health utilization. The results show the increased influence of PTSD symptoms on medical health care services when pain ratings are high and suggest the need for interdisciplinary pain clinics that are able to address the overlapping symptoms of pain and common mental health conditions. Implication of results for VA planning are discussed.

미국내 아시아 이민자들의 의료서비스 이용에 영향을 미치는 요인

Purpose: This study was considered in order to identify the factors affecting healthcare utilization by Asian immigrants in the United States. Methods: From February to April 2011, a descriptive survey study was conducted in a convenience sample of 250 Korean and Asian Indian immigrants aged between 40 and 64 in the Triangle area of North Carolina. An author-developed instrument was used to assess predisposing, enabling, and need factors according to Anderson's Behavioral Model of Health Services. Utilization Data analysis was performed by <TEX>$X^2$</TEX>-test, t-test, and binary logistic regression. Results: Participants' healthcare services experiences were significantly different when they had a longer stay in the U.S., had been employed, had higher income, were Asian Indians, had better English-speaking skills, better health status, more knowledge of health system and health insurance, had higher satisfaction with the healthcare system, and when they were taking prescribed medications and having health insurance. The strongest association with experience of healthcare services was having health insurance with an adjusted odds ratio (OR) of 15.37 (95% CI 4.95-47.71, p<.001) and self-reported English proficiency (OR=1.99, 95% CI 1.00-3.96, p=.05). Conclusion: Intervention strategies to increase accessibility to healthcare services should focus on these significant predictors.

Factors Affecting Health Care Utilization in Tehran.

Introduction:Successful health system planning and management is dependent on well informed decisions, so having complete knowledge about medical services’ utilization is essential for resource allocation and health plans. The main goal of this study is identification of factors effecting inpatient and outpatient services utilization in public and private sectors.Methods:This study encompasses all regions of Tehran in 2011 and uses Urban HEART questionnaires. This population-based survey included 34700 households with 118000 individuals in Tehran. For determining the most important factors affected on health services consumption, logit model was applied.Results:Regarding to the finding, the most important factors affected on utilization were age, income level and deciles, job status, household dimension and insurance coverage. The main point was the negative relationship between health care utilization and education but it had a positive relationship with private health care utilization. Moreover suffering from chronic disease was the most important variable in health care utilization.Conclusions:According to the mentioned results and the fact that access has effect on health services utilization, policy makers should try to eliminate financial access barriers of households and individuals. This may be done with identification of households with more than 65 or smaller than 5 years old, people in low income deciles or with chronic illness. According to age effect on health services usage and aging population of Iran, results of this study show more importance of attention to aged population needs in future years.

의료보장유형에 따른 Percutaneous Transluminal Coronary Angioplasty 입원 환자의 의료이용 차이 분석: Propensity Score Matching을 이용하여

Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn’t show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

Factors Affecting Health Care Utilization for Children in Japan

Studies on the ecology of medical care for children have been reported only from the United States. Our objective was to describe proportions of children receiving care in 6 types of health care utilization seeking behaviors in Japan on a monthly basis and to identify care characteristics. A population-weighted random sample from a nationally representative panel of households was used to estimate the number of health-related symptoms, over-the-counter medicine doses, and health care utilizations per 1000 Japanese children per month. Variations in terms of age, gender, socioeconomic status, and residence location were also examined. Based on 1286 households (3477 persons including 1024 children) surveyed, on average per 1000 children, 872 had at least 1 symptom, 335 visited a physician's office, 82 a hospital-based outpatient clinic, 21 a hospital emergency department, and 2 a university-based outpatient clinic. Two were hospitalized, and 4 received professional health care in their home. Children had 2 times more physician visits and 3 times more emergency visits than adults in Japan, and Japanese children had 2.5 times more physician visits and 11 times more hospital-based outpatient clinic visits than US children. Pediatric health care utilization is influenced significantly by age but not affected by income or residence location in Japan. Compared with the data from the United States, more children in Japan visit community physicians and hospital-based outpatient clinics. Results of this study would be useful for further delineation of health care utilization of children in the context of a health care system unique to Japan.

Factors Affecting Health Care Utilization for Children in Japan

Factors Affecting Health Care Utilization for Children in Japan

Intensity of Acute Care Services at the End of Life: Nonclinical Determinants of Treatment Variation in an Older Adult Population

Technological advances in medicine have led to increasing complexity in health care decision making, and subsequently, greater opportunity for variation in the delivery of end-of-life care. Factors such as age, race/ethnicity, physician and hospital system characteristics, and geographic location have been found to be strong predictors of variation in acute interventions before death, even when controlling for medical acuity. The study presented here explores factors affecting health care utilization at end of life for a hospitalized older adult population in a major metropolitan area of Arizona. The study results reveal that effects of age, minority status, health plan, and hospital characteristics all affect hospital utilization and intensity of care above and beyond clinical factors.

Financial, organizational and professional factors affecting health care utilization

This paper explores the effects of specific provider and system features on patients' use health care, including financial, time and organizational barriers, practice patterns and physician characteristics. The data are from a survey of 3058 family members and their usual providers in Washington, D.C. Findings indicate that a low-income practice clientele and high charges were the most significant deterrents to use, followed by absence of Medicaid, distance, limited hours and patient-sharing by physicians. Charges and distance had a disproportionate impact on the poor. The combined impact of structural barriers in hospital outpatient departments reduced access by roughly 50% compared with private settings. Policy implications are discussed.