Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation
Titelübersetzung:Ungleichheit bei der medizinischen Versorgung in Deutschland? Theoretische und empirische Evidenz für den Facharztbesuch
Autor/in:
Gruber, Stefan; Kiesel, Markus
Quelle: Journal of Public Health, 18 (2010) 4, S 351-365
Inhalt: Aim: In view of increasing concern about a two-class system in the German health care sector, this study investigates the relevance of health insurance schemes and other socioeconomic characteristics to the level of specialist health care provision. Subjects and Methods: Referring to Ronald M. Andersen’s model of health care utilization and more content-based approaches, we implement a negative binomial hurdle regression to estimate the number of specialist visits within the last 12 months. Our data source is the German sample of the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004. Results: The results show that men’s number of specialist visits is markedly sensitive to predisposing and enabling factors, whereas women’s health care utilization depends less on such socioeconomic characteristics. With reference to previous findings concerning general practitioner consultation, the assumption of a bipolar health care system providing general practitioner care primarily to the statutory insured and specialist care to the privately insured is supported empirically as to men. Education, which is considered to be highly correlated with health lifestyles, has a positive effect on medical health care. Every additional year of education increases by about 10% the probability of men seeking specialist consultation. Furthermore, the results indicate an unfavorable situation for the self-employed concerning health care because of their specific employment situation and health insurance coverage. Discussion: The research results suggest the existence of relevant differences in the amount of specialist consultation according to health insurance and other socioeconomic features. Further research could concentrate on the question of whether these inequalities in utilization levels indicate overprovision or underprovision of ambulant health care. Moreover, we recommend longitudinal research that is particularly suited to detangle age and cohort effects.
Schlagwörter:theory-practice; Theorie; statistische Analyse; health care delivery system; Facharzt; Gesundheitswesen; compulsory health insurance; Federal Republic of Germany; Theorie-Praxis; private health insurance; private Krankenversicherung; man; gesetzliche Krankenversicherung; inequality; statistical analysis; Lebenserwartung; medical specialist; model; health care; life expectancy; Modell; Gesundheitsversorgung; woman; Mann; theory; Ungleichheit; Specialist consultation; Health care utilization; Health insurance; Supply-induced demand; Hurdle regression
Quelle: Journal of Public Health, 18 (2010) 4, S 403-411
Inhalt: Aim: The first goal of this study was to assess the prevalence of different health risk behaviours among Romanian young people. Next, the interrelationship between different health risk behaviours as well as age and gender differences with respect to health risk behaviours were examined. Subjects and methods: Self-administered questionnaires were completed by a sample of 1,598 junior high school students, senior high school students and university students from urban and rural areas of two counties of Romania. Results: The results showed that 31% of junior high school students, 59.7% of senior high school students and 64.8% of university students reported more than one risk behaviour. Many of the risk behaviours were likely to correlate with each other and the strongest correlation was found between smoking, alcohol-related behaviour and precocious sexual intercourse. Factor analysis revealed that among junior high school students all health risk behaviours loaded on one factor. In senior high school students and university students the risk behaviours split into two factors, based probably on their frequency and severity. Factor 1 comprised smoking, alcohol-related behaviours as well as precocious sexual intercourse, while factor 2 included less common behaviours: violence, delinquency and illicit drug use. No gender differences were observed regarding the relationship between health risk behaviours. Conclusion: The results stress the importance of developing prevention programmes among Romanian youth for the behaviours discussed. Further research is needed to identify how to best offer these programmes: as stand-alone programmes or as an integrated set of programmes and whether the same approach has to be taken for younger and older adolescents.
Schlagwörter:Drogenkonsum; drug use; Gesundheit; female pupil; Student; student; Prävention; tobacco consumption; Sexualverhalten; Tabakkonsum; pupil; prevention; Gesundheitspolitik; Romania; Jugendlicher; sex behavior; alcohol consumption; Schülerin; Rumänien; Risikoverhalten; Schüler; health policy; Gesundheitsverhalten; gender; adolescent; health education; Alkoholkonsum; Gesundheitserziehung; risk behavior; health behavior; health; Health risk behaviours; Romanian adolescents; Health education
SSOAR Kategorie:Bildungswesen Sekundarstufe I, Medizinsoziologie, Gesundheitspolitik, Bildungswesen Sekundarstufe II
Attitudinal and socio-structural determinants of cervical cancer screening and HPV vaccination uptake: a quantitative multivariate analysis
Titelübersetzung:Einstellung und soziostrukturelle Determinanten zu Gebärmutterkrebs-Screening und HP-Virus-Schutzimpfung: eine quantitativ-multivariate Analyse
Quelle: Journal of Public Health, 18 (2010) 2, S 179-188
Inhalt: Aim: The introduction of the human papillomavirus (HPV) vaccine enables for the first time in the history of cancer prevention the possibility of combating the major cause of a cancer even before its onset. The secondary prevention measure of cervical cancer screening has thus been complemented by a primary prevention measure. The aim of this study is to analyse the determinants of uptake of preventive measures against cervical cancer as a basis for comparing the determinants of screening attendance with those of HPV vaccination attendance. Subject and methods: A population-based representative survey comprising 760 randomly selected women aged 14 to 65 was performed in the German federal state of Mecklenburg-Western Pomerania. Prevention behaviour, attitudes towards cervical cancer screening and HPV vaccination, and knowledge about cervical cancer and HPV were investigated by means of a structured questionnaire. Descriptive analyses and multivariate logistic regression analyses were conducted to identify the determinants of screening and HPV vaccine uptake. Results: Attendance both at screening and at HPV vaccination was best predicted by attitudinal factors. Positive connotations of cancer prevention measures and utility expectations, fear of cancer and high subjective risk perception were conducive to attendance at screening and HPV vaccination. Screening attendance was less regular among women of lower socioeconomic status. In contrast, HPV vaccination uptake was higher for young women with lower educational attainment and lower social class. Knowledge did not impact prevention behaviour significantly. There is no trade-off between screening and vaccination attendance; the vast majority of respondents was aware of the necessity of regular screening attendance even when vaccinated against HPV. Conclusions: Uptake rates for existing primary and secondary prevention measures against cervical cancer can be enhanced by fostering perceptions of utility and positive connotations of regular screening and becoming vaccinated against HPV. Elderly women in particular should be encouraged to attend screening by means of a recall system. Given the low overall level of knowledge about cervical cancer and its risk factors, there is a need for education about the necessity and utility of prevention to reach women of all social classes.
Schlagwörter:Gesundheit; vaccination; Prävention; risk; cancer; determinants; preventive medical examination; prevention; sozioökonomische Faktoren; Federal Republic of Germany; Vorsorgeuntersuchung; Mecklenburg-Western Pomerania; Gesundheitsvorsorge; Gesundheitsverhalten; knowledge; attitude; Risiko; health care; Krankheit; socioeconomic factors; woman; Mecklenburg-Vorpommern; Krebs; Impfung; Determinanten; health behavior; Risikoabschätzung; health; illness; Wissen; risk assessment; Einstellung; Cervical cancer prevention; Cervical screening; HPV vaccination; Attitudes; Socio-structural determinants; soziostrukturelle Faktoren
Quelle: Journal of Public Health, 18 (2010) 5, S 489-496
Inhalt: Aim: This study aimed to describe perceptions and experiences related to access and utilization of health care services of African and Brazilian immigrant women in Portugal. Subjects and methods: Six focus groups were conducted with 35 African and Brazilian women with low income and living in Lisbon, chosen through purposive sampling. Content analysis was undertaken through identification of themes and categories. Results: African and Brazilian women expressed different perceptions and patterns of use of health care services. Most participants pointed out several barriers to access and utilization of services related to legal issues, economic constraints or health professionals' attitudes. Conclusion: These results highlight the challenges to providing health care within a multicultural setting and the need to assure the provision of integrated and comprehensive health care services. Improving access to general health care is essential in order to minimize disadvantages from vulnerable subgroups, like immigrant women. Supporting better integration into the health system may lead to improved health outcomes.
Schlagwörter:perception; Afrikaner; Gesundheit; discrimination; health care delivery system; Wahrnehmung; Gesundheitswesen; African; Erfahrung; Diskriminierung; Migrant; Benchmarking; sozioökonomische Faktoren; Einwanderung; attitude; benchmarking; migrant; Krankheit; socioeconomic factors; comparison; woman; Portugal; Portugal; sociocultural factors; soziokulturelle Faktoren; immigration; health; Vergleich; illness; Einstellung; experience; Immigrant women; Perceptions; Experiences; Access and utilization of health care services
Results from the National Strategy for improvement of iodine nutrition in Bulgaria: a study of children and pregnant women living in an iodine-deficient area
Autor/in:
Gatseva, Penka D.; Bivolarska, Anelia V.; Argirova, Mariana D.
Quelle: Journal of Public Health, 19 (2010) 3, S 237-240
Inhalt: Background: A significant part of Bulgaria is considered an iodine-deficient area. The National Strategy for Prevention and Control of Iodine Deficiency Disorders (IDD) was developed in 1994, and regular surveys undertaken in 2000–2003 indicated a normalization of the iodine supply in the Bulgarian population, including some at-risk population groups (children, schoolchildren, pregnant women). Despite the results achieved, mandating periodic cohort surveys for tracking the elimination of iodine deficiency is necessary. Objective: The aim of this study was to evaluate the results of the the national strategy for improvement of iodine nutrition in children and pregnant women living in an iodine-deficient area in Bulgaria 15 years after its update. Subjects and methods: Study subjects were 73 children aged 9.21 ± 2.07 years (29 boys and 44 girls) and 16 pregnant women living in the town of Asenovgrad. Urinary iodine concentration was measured and used as an index of iodine intake. Results: The median urinary iodine of the inspected children was between 100–199 μg/l, which is an indicator of optimal iodine nutrition. Almost 1/3 of the children (31.5%) had iodine deficiency. The median urinary iodine concentration of the 16 pregnant women investigated was 127.0 μg/l, which is an indicator of insufficient iodine intake. Conclusion: Despite the normalization of the iodine supply in the past years in the at-risk population groups of children and pregnant women, a considerable portion of them still has iodine deficiency. Recommendations for improving health education and iodine nutrition in at-risk population groups were made.
Quelle: Journal of Public Health, 19 (2010) 3, S 269-280
Inhalt: Aim: The aim of this study was to analyse the health-related quality of life (HRQOL) of primary family caregivers in comparison to the reference values of the average population. Subjects and methods: Data collection took place in the Werra-Meißner district in 2009 with a response rate of 102 primary family caregivers of frail elderly people. The health-related quality of life was measured with the Short Form 36 health survey (SF 36) and compared with the German reference values. Results: Compared to the health values of the normative sample, primary caregivers show significantly lower rates in all dimensions of health-related quality of life. In particular, caregivers between the ages of 53 to 61 report extremely low health values. Caregiving women compared to non-caregiving women have highly significant differences in all subscales of the SF 36. Caregiving men also report highly significant differences to non-caregiving men in all dimensions of the SF 36 except for Physical Functioning and General Health (p < 0.01). Caregivers in general and especially caregiving women aged 53 to 61 (midlife) were identified as at-risk groups for poor health. The latter report lower vitality and well-being, which may be a consequence of both social isolation and social impacts from multiple role demands. Conclusion: The identified high-risk groups of family caregivers, caregivers in midlife and especially caregiving women in midlife, should be supported by social measures, e.g., training courses for family caregivers, particularly in their home setting, and various types of respite care in order to sustain their health.
Schlagwörter:psychische Belastung; Gesundheit; alter Mensch; family member; Lebensqualität; Hessen; risk; health consequences; Federal Republic of Germany; häusliche Pflege; nursing care for the elderly; psychological stress; quality of life; Auswirkung; Risiko; home care; Krankheit; Altenpflege; Hesse; impact; elderly; gesundheitliche Folgen; gender-specific factors; health; Familienangehöriger; illness; family caregiver; health-related quality of life; SF 36; gender differences