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
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