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Since health behaviors of elderly Asian Americans are often underreported, the study, based on the health behavioral model (Andersen’s model), was to examine if there is a reciprocal relationship between healthcare utilization and health outcomes, and how social characteristics play their role in this relationship between US-born and foreign-born elderly Asian Americans.

Using structural equation modeling, this research examined the proposed hypotheses which consisted of direct and indirect effects among health outcomes, healthcare utilization and social characteristics, as well as the disparities of the effects between US-born and foreign-born elderly Asian Americans (65 + ). A sample size of elderly Asian Americans was divided into a US-born group (N = 1,305) and a foreign-born group (N = 4,902) from the National Health Interview Survey (NHIS) 1998–2012. Health outcomes consisted of current health status and health change. Healthcare utilization included general doctor visit, ER, and mental health professional visit. Social characteristics of population included predisposing characteristics (such as age, sex, marital status, and region of residency) and enabling resources (such as education, family size, and family income).

Results from the study indicated that first, there was a reciprocal relationship between health outcomes and healthcare utilization for both groups. Second, predisposing characteristics had a direct effect on health outcomes, and enabling resources had an indirect effect on health outcomes via healthcare utilization. In addition, living in the West had both direct and indirect effects on health outcomes. Third, regarding disparities of the effects between both groups, the US-born elderly are more likely to attain health benefits from healthcare utilization and their social characteristics than the foreign-born. As a result, the interactive relationship between health outcomes, healthcare utilization, and social characteristics, as well as disparities of healthcare outcomes through health utilization and social characteristics for elderly Asian Americans is highlighted.

First, due to the design of NHIS, this research was limited to fully present the needs and more characteristics of elderly Asian Americans. This shows the great need for a large scale, representative study for health behaviors of elderly Asian Americans. Second, in the dataset, the study was limited to explore health behaviors of elderly Asian Americans into each Asian ethnic subgroup. Since the culture of Asian Americans is heterogeneous, it is recommended that future research can explore differences and commonalities of the health behaviors between Asian subgroups. Third, based on the health behavioral model and the design of the dataset, this study was limited to illustrate variations of life experiences between both groups. These differences regarding their needs and desires for healthcare services and health outcomes can become an important foundation for service providers and policy makers to provide appropriate services that improve the quality of the later lives of elderly Asian Americans.

First, the study applied the health behavioral model and proved that the effect of healthcare utilization and social characteristics on health outcomes is greater for the US-born elderly Asian Americans than for the foreign-born. Second, this study confirmed that the healthcare services in US society are still beneficial for the health outcomes of elderly Asian Americans. Third, the study found that when family is used to explain the social behaviors of elderly Asian Americans, researchers need to be more careful to identify various family factors in accordance to its dynamics, such as interpersonal relationship, material supply, and emotional support.

It can be said that the most important function of the health system is to provide health-care services. This directly affects society’s health and justice. To the best of the authors’ knowledge, this study is the first study that has meta-analyzed the percentage of health services utilization among Iranians to answer this question “How much is the percentage of health-care services utilization in Iran?”

This study is a systematic review and meta-analysis conducted in 2020. The literature review was done by searching the databases of Google Scholar, Scopus, PubMed, Web of Science, Science Direct, SID, Magiran and Irandoc from January 2010 to August 2020. Pooled utilization percentage (UP) was estimated by STATA 15 through random-effects meta-analysis with 95% confidence interval. The I² statistic was used to investigate the possibility of heterogeneity of articles (I² ≥ 50% indicate heterogeneity). A forest plot was applied to report the results. A funnel plot exploited due to publication bias assessment.

Approximately 22% of the reviewed articles have been done at the national level of Iran. Most studies have examined the utilization of outpatient and inpatient services. Based on the random effects method, the pooled value of UP was obtained at 47.82%, (95% CI: 39.33–56.31). Also, the pooled percentage of utilization was statistically significant (Test of UP = 0, Z = 456.44, p = 0.000).

Policymakers can improve the level of utilization from health services by expanding universal coverage, expanding insurance coverage and removing direct and indirect barriers.

To the best of the authors’ knowledge, this is the first systematic review and meta-analysis on health services utilization in Iran that completely considers the utilization rate in all health services and states the practical solutions to cope with utilization deficiencies and barriers.

The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia.

Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed.

Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data.

This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals.

This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.

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.

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 study examined the utilisation patterns of healthcare services among tea garden workers and analysed the factors influencing utilisation in an Indian context.

The authors employed a mixed-method approach and an explanatory sequential design for the study. A survey was conducted in the beginning followed by in-depth interviews in a north-eastern state of India (Assam). Andersen health behaviour model was used to explore the factors influencing healthcare utilisation. The sample size for the survey and in-depth interviews were 300 and 19, respectively, recruited employing multistage random and purposive sampling techniques.

Out of 300 workers surveyed, 169 (56.3%) were females, 257 (85.7%) were married, 77 (25.7%) were illiterates and 229 (76.3%) had monthly household income less than 100 US$. The survey also found that 47.3% and 15.3% had non-communicable and communicable disease respectively. Most of the workers (67.3%) utilised government facilities, and close to one third (28.7%) utilised tea garden hospitals. About 63.3% had health insurance, but a majority (78.9%) did not use it previously. The analyses of interviews explored the need, enabling, predisposing factors under three important themes influencing utilisation of healthcare services among the workers.

The study generates evidence to strengthen the Indian Plantation Labour Act, 1951 for tea garden worker's welfare protection and warrants transition from colonial-era policies to contemporary industry realities in order to improve their living, employment, nutritional and health conditions.

The research adds to the existing literature on overall healthcare services utilisation (including coverage and utilisation of health insurance) among blue collar workers who usually lack access to healthcare facilities and explores important factors that determine utilisation in the Indian context.

Purpose – To examine potential sex differences among American Indian and Alaska Native peoples (AIANs) in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs within the Indian Health Services (IHS).

Methodology/Approach – Data were drawn from the IHS Improving Healthcare Delivery Data Project with 437,608 persons in our analytical sample. We described sex and age differences in diabetes, comorbidities, healthcare utilization, and treatment costs among the adults with diabetes. We evaluated the statistical differences between men and women using confidence intervals calculated at the 95% level, with nonoverlapping confidence intervals indicating statistical significance.

Findings – The prevalence of diabetes among females was somewhat higher than that of males (10.82 vs 9.16%, respectively, p < 0.05). Among adults with diabetes, males had statistically higher prevalence of hypertension, cardiovascular disease, and substance use disorders and fewer mental health disorders compared to females. Although males had overall lower average cost of services than females, males had higher utilization for hospital inpatient services than females, and females used more outpatient services.

Research limitations/implications – We are limited to one fiscal year of data and thus cannot predict the influence of healthcare utilization patterns on the overall health of this population. Although a large sample, the findings are only generalizable to the active users of the participating IHS Service Units.

Originality/Value of Paper – This study fills a major gap in our knowledge of sex differences in diabetes prevalence, comorbidities, healthcare utilization, and treatment costs among AIANs. Differences in the comorbidities that characterized the AIAN adult males and females with diabetes in this sample have important implications for mortality and cost of care. Diabetes management that addresses such gender-specific comorbidities, particularly substance use disorders among men and mental health disorders among women, promises to reduce these comorbidities and related complications.

The reasons for and experiences during migration, as well as additional stressors in the new host country, may give rise to mental health problems and additional need for public services. The purpose of the study was to investigate factors related to service utilization among newly arrived refugee youth.

Cross-sectional data were gathered in Sweden where 37 youth aged between 19 and 23 reported on factors related to service utilization, encompassing health-care and support services in school. These factors included predisposition (demographic), need (migration status and mental wellbeing) and enablement (living situation). Service utilization was estimated using multiple logistic regression analysis.

About a fourth of the sample used psychosocial services. Use of general support was more common. Neither predisposing, need nor enabling factors were associated with the use of psychosocial or general health-related services.

Self-reported factors related to use of health-related services have previously not been investigated for refugee youth, which is important in assuring access to appropriate services for this exposed youth population.

The purpose of this paper is to analyze patterns of health services utilization – visits to family practitioner and visits to an emergency room – by recent immigrants (those who have lived in Canada for less than ten years) and “established” immigrants (those who have resided in Canada for ten years or longer) relative to their Canadian-born counterparts.

The 2009/2010 files of the Canadian Community Health Survey were used for the analysis. A logit model was used to analyze utilization while a zero-inflated negative binomial model was used to measure the intensity of health services utilization.

Results suggest that relative to native-born Canadians, recent immigrants are more likely to visit an emergency room and are less likely to visit a family/general practitioner. The opposite effect is observed for “established” immigrants. In terms of intensity of use, native-born Canadians are more likely to use physicians’ services intensively compared with either recent or established immigrants.

The paper’s findings suggest that provincial governments in Canada will need to focus effort to ensure that recent immigrants have access to a family/general practitioner. This will be necessary given the recent primary care reform initiatives introduced across Canada that emphasize the physician as the first point-of-contact with the health system.

The purpose of this chapter is to examine geographic variations in utilization and need for mental health services. Data for this study were obtained from the 2002 National Survey of American Families. The total sample size was 23,327 adults of aged 18 years and older. Both logistic and linear regression were used to test the possibility of geographical variations. Disparities were found among the 13 U.S. states examined in this study. Results also showed that the percentage of African Americans, state mental health budgets, and mean length of stay in psychiatric hospitals in the state are important predictors of variations in mental health utilization and need variables. These findings suggest that although individual sociodemographic characteristics are important in examining mental health utilization, state characteristics (especially percentage of African Americans, state mental health laws, and mean length of stay in psychiatric hospitals) are also important predictors of variation in utilization of mental health services.