Search results

The purpose of this paper is to estimate the key socio‐economic and demographic factors influencing the utilization of antenatal care services in Ghana.

The paper utilizes the most recent Ghana Demographic and Health Survey (GDHS V) data. The dependent variable is the intensity of utilization (number) of antenatal care visits. Hence, the negative binomial regression is employed to investigate the socio‐economic and demographic correlates of the intensity of antenatal care utilization in Ghana.

The study finds that wealth status, age, ownership of health insurance (especially for rural women), educational attainment, birth order, religion and administrative region of residence are significant predictors of the intensity of antenatal care services utilization. In particular, the utilization rate increases in wealth status. The authors also found significant statistical relationship between residence and antenatal care utilization. This finding reinforces the differences in health facilities between the rural and urban areas of Ghana. The authors did not, however, find evidence for proxies for financial and physical access.

The GDHS survey lacks data on the distance to the nearest health facility where ANC is sought and a variable for the price of ANC visit. Proxies had to be used to capture these variables.

The fact that ownership of health insurance in rural areas increases the number of ANC visits makes it imperative to intensify health insurance awareness and enrollment campaigns in the rural areas so as to bridge the rural‐urban gap in ANC utilization. Also, while the free maternal health care policy for expecting mothers is laudable, a minimum level of wealth is required to induce antenatal care visitations. This is because household wealth status still plays a major role even in a free maternal health regime.

A new finding of the paper is the significant effect that ownership of health insurance has on the utilization of ANC services among rural women. While generally rural women have a lower propensity to use ANC services compared to urban women, the intensity of usage of ANC services tends to increase for rural women who own health insurance.

The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.

The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.

While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.

The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.

The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.

Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4.

Methodology/approach – A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression.

Findings – This study found that dual eligible RHC patients utilized ER services at higher rates than nondual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively.

Research limitations/implications – Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in CMS Region 4.

Originality/value – In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 years and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.

The paper defines the concept of inequity in health care and reviews the various approaches to identify causal relationships which lead to inequitable health outcomes. Notably, the input and process of health care delivery, the medical and social need factors, the external environment and the indirect influences channeled through ‘mediating’ factors. It further proposes a comprehensive model which integrates the combined effects of the several categories of components involved in determining inequitable outcomes between groups and individuals. While not exhaustive, the model provides a systematic attempt to define and trace inequities in health and potential causes of such, in operational terms. It can be used, therefore, for practical measurement of levels of inequity in outcomes.

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization.

The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care.

Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors.

This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access.

The research offers a tactical framework for management to segment consumer markets more effectively.

Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome.

The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.

This paper reports an analysis of the evolution of equity in the utilisation of health care in Spain over the period 1987–2001, a time span covering the development of the modern Spanish National Health System. Our measures of utilisation are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures, we obtain indices of horizontal inequity from microeconometric models of utilisation that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001, the system had improved insofar as differences in income no longer lead to differences in utilisation given the same level of need. However, tenure of private health insurance leads to differences in utilisation given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilisation for the three services has also increased.

The study aims to examine the socio‐economic determinants of maternal health services utilization in Ghana.

Probit and ordered probit models are employed in this study.

The results generally indicate that most women in Ghana undertake the required visits for antenatal services and also take both doses of the tetanus toxoid vaccine as required by World Health Organization. However, the results show low levels of usage in terms of the other maternal health care services (i.e. prenatal care, delivery at a health facility, and postnatal care). There is clearly an urgent need to develop innovative strategies that will help upscale intervention especially for improvement in the use of these services by women in Ghana. The regression results reveal that utilization of maternal health services and intensity of use of antenatal services are influenced by age of mother, type of birth, education of mother, ethnicity, economic status, geographic location, residence, and religious affiliation. Obviously, this suggests that more than medical factors are responsible for the differences in the use of maternal health services by women in Ghana as well as the decision on the number of visits to undertake with respect to antenatal visits.

The findings of this study have important implications for health policy formulation targeted at improving maternal health care service utilization.

This paper uses a unique nationwide survey data derived from the 2003 Utilisation of Health Services Survey (UHSS) in Iran (n=16,935) to analyse inequities of health care utilisation.

Concentration indices are used to measure socioeconomic inequality in actual use of the five types of health services, and in unmet need for two of those types of service (any ambulatory care and hospital admissions). Horizontal inequity indices are employed to examine inequity in ambulatory and hospital care. Generalised linear model (GLM) was employed to investigate factors contributing to the phenomena of “unmet need” and “met unneed”. Moreover, a decomposition analysis of inequality is performed to determine the contributions of each factor to the inequality of “unmet need”.

Results suggest that self‐reported need for ambulatory and inpatient care is concentrated among the poor, whereas the utilisation of ambulatory and inpatient care were generally distributed proportionally. Results of horizontal inequity indices show that the distributions of any ambulatory care and hospital admissions are pro‐rich. The probability of “unmet need” for ambulatory care was higher among wealthier individuals. The decomposition analysis demonstrates that the wealth index, health insurance, and region of residence are the most important factors contributing to the concentration of “unmet need” for ambulatory health care among the poor. Results also illustrate that higher wealth quintiles used more unneeded ambulatory care than their poorer counterparts.

A special characteristic of the UHSS is that it contains questions about the need for medical services use and about actual services use. This characteristic provides an opportunity to measure the inequality of health care consumption against self‐assessed treatment needs, as well as an analysis of which observables are associated with “unmet need”. Moreover, the incidence of health care use when it is reported as not needed can be analysed with this dataset. The analysis of this phenomenon – which we refer to as “met unneed” – is another novel aspect of this work.

Despite the biological and clinical advances in oral health, dental disease is still a problem for those of low socioeconomic (SE) status, as well as racial and ethnic minorities. In this study, we use the Andersen Behavioral Model of predisposing, enabling, and need factors to examine the effects of race, ethnicity, and income on dental care utilization. Using the Medical Expenditure Panel Survey (MEPS) household component and dental event data (n=8,685), we tested the hypothesis that longer survival or delay in dental care utilization is associated with both minority and lowered SE statuses. Analyses confirm that minority status, income, and education, are predictive of the delay in dental care utilization. This study lends support to the theorized assumption that there are racial and ethnic differences in the pattern of dental care utilization and that these differences as well as other factors contribute to disparity in dental care utilization.