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学科主题: 精神卫生
题名:
Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria
作者: Albanese, Emiliano1; Liu, Zhaorui2; Acosta, Daisy3; Guerra, Mariella4; Huang, Yueqin2; Jacob, K. S.5; Jimenez-Velazquez, Ivonne Z.6; Llibre Rodriguez, Juan J.7; Salas, Aquiles8; Sosa, Ana L.9; Uwakwe, Richard10; Williams, Joseph D.11; Borges, Guilherme12,13; Jotheeswaran, A. T.1,14; Klibanski, Milagros G.15; McCrone, Paul1; Ferri, Cleusa P.1; Prince, Martin J.1
刊名: BMC HEALTH SERVICES RESEARCH
发表日期: 2011-06-28
DOI: 10.1186/1472-6963-11-153
卷: 11
收录类别: SCI ; SSCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Health Care Sciences & Services
研究领域[WOS]: Health Care Sciences & Services
关键词[WOS]: CHRONIC DISEASES ; MENTAL-HEALTH ; GENDER-DIFFERENCES ; INCOME COUNTRIES ; POPULATION ; SERVICES ; PREVENTION ; MORTALITY ; LIFE
英文摘要:

Background: To describe patterns of recent health service utilisation, and consequent out-of-pocket expenses among older people in countries with low and middle incomes, and to assess the equity with which services are accessed and delivered.

Methods: 17,944 people aged 65 years and over were assessed in one-phase population-based cross-sectional surveys in geographically-defined catchment areas in nine countries - urban and rural sites in China, India, Mexico and Peru, urban sites in Cuba, Dominican Republic, Puerto Rico and Venezuela, and a rural site in Nigeria. The main outcome was use of community health care services in the past 3 months. Independent associations were estimated with indicators of need (dementia, depression, physical impairments), predisposing factors (age, sex, and education), and enabling factors (household assets, pension receipt and health insurance) using Poisson regression to generate prevalence ratios and fixed effects meta-analysis to combine them.

Results: The proportion using healthcare services varied from 6% to 82% among sites. Number of physical impairments (pooled prevalence ratio 1.37, 95% CI 1.26-1.49) and ICD-10 depressive episode (pooled PR 1.21, 95% CI 1.07-1.38) were associated with service use, but dementia was inversely associated (pooled PR 0.93, 95% CI 0.90-0.97). Other correlates were female sex, higher education, more household assets, receiving a pension, and health insurance. Standardisation for age, sex, physical impairments, depression and dementia did not explain variation in service use. There was a strong borderline significant ecological correlation between the proportion of consultations requiring out-of-pocket costs and the prevalence of health service use (r = -0.50, p = 0.09).

Conclusions: While there was little evidence of ageism, inequity was apparent in the independent enabling effects of education and health insurance cover, the latter particularly in sites where out-of-pocket expenses were common, and private health insurance an important component of healthcare financing. Variation in service use among sites was most plausibly accounted for by stark differences in the extent of out-of-pocket expenses, and the ability of older people and their families to afford them. Health systems that finance medical services through out-of-pocket payments risk excluding the poorest older people, those without a secure regular income, and the uninsured.

语种: 英语
所属项目编号: GR066133 ; GR08002
项目资助者: Wellcome Trust ; GlaxoSmithKline ; Novartis ; Lundbeck ; Pfizer ; Eisai
WOS记录号: WOS:000293282100001
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/52183
Appears in Collections:北京大学精神卫生研究所_期刊论文

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作者单位: 1.Kings Coll London, Inst Psychiat, Hlth Serv & Populat Res Dept, London WC2R 2LS, England
2.Peking Univ, Inst Mental Hlth, Beijing 100871, Peoples R China
3.UNPHU, Dept Internal Med, Geriatr Sect, Santo Domingo, Dominican Rep
4.Natl Inst Mental Hlth Honorio Delgado Hideyo Nogu, Psychogeriatr Unit, Lima, Peru
5.Christian Med Coll & Hosp, Vellore, Tamil Nadu, India
6.Univ Puerto Rico, Sch Med, Geriatr Program, Dept Internal Med, San Juan, PR 00936 USA
7.Med Univ Havana, Fac Med Finley Albarran, Havana, Cuba
8.Cent Univ Venezuela, Fac Med, Caracas Univ Hosp, Dept Med, Caracas, Venezuela
9.Natl Inst Neurol & Neurosurg Mexico, Cognit & Behav Unit, Mexico City, DF, Mexico
10.Nnamdi Azikiwe Univ Teaching Hosp, Nnewi, Anambra State, Nigeria
11.Voluntary Hlth Serv, Dept Community Hlth, Madras, Tamil Nadu, India
12.Inst Nacl Psiquiatria, Mexico City, DF, Mexico
13.Univ Autonoma Metropolitana, Mexico City, DF, Mexico
14.Publ Hlth Fdn India, Delhi, India
15.Policlin 14 Junio Luyano Municipio 10 Octubre, Havana, Cuba

Recommended Citation:
Albanese, Emiliano,Liu, Zhaorui,Acosta, Daisy,et al. Equity in the delivery of community healthcare to older people: findings from 10/66 Dementia Research Group cross-sectional surveys in Latin America, China, India and Nigeria[J]. BMC HEALTH SERVICES RESEARCH,2011,11.
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