Volume 15, Issue 4 (Winter 2021)
Salmand: Iranian Journal of Ageing 2021, 15(4): 410-427 |
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Tajvar M, Yaseri M, Karami B, Mohammadi M. Pattern of Outpatient Health Service Utilization by Older People in Iran. Salmand: Iranian Journal of Ageing 2021; 15 (4) :410-427
URL: http://salmandj.uswr.ac.ir/article-1-1984-en.html
URL: http://salmandj.uswr.ac.ir/article-1-1984-en.html
1- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,maria.mohammadi1395@gmail.com
2- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. ,
Abstract: (5076 Views)
Objectives: Considering the rapid growth of Iran’s elderly population with consequent increase in the costs of health services, it is necessary to be aware of the pattern of outpatient health service utilization, in the elderly for resource allocation and health planning. This study aims to determine the pattern of outpatient service utilization for the elderly in Iran and explore determinant factors.
Methods & Materials: This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services.
Results: Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services.
Conclusion: Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.
Methods & Materials: This is a cross-sectional study using secondary analysis method and the data from 2015 National Study of Health Service Utilization. Study population consists of older people aged ≥60 years. Of these, 8205 were selected as study samples. The data were collected using personal and household questionnaires collecting information on subjects’ need for, referral to, utilization from, and satisfaction with outpatient services. Logistic regression analysis was used to identify factors related to the need, referral, benefit, and satisfaction with the received outpatient services.
Results: Out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (N=2060) benefited outpatient services. Females, older subjects, villagers, unmarried and illiterate subjects were more in need of outpatient services, but their referrals to receive the services were not more than those of other groups. Lack of basic insurance, supplementary insurance, and a personal care had a significant impact on reducing the number of subjects referred to receive outpatient services. Inability to pay treatment costs (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons for not referring to receive outpatient services. The highest satisfaction was related to the behavior of physicians and medical staff and the lowest satisfaction was related to the cost of outpatient services.
Conclusion: Although the use of outpatient health services should be based on the need for these services, the present study showed that the older people with higher socio-economic status had higher utilization from the services in Iran. Therefore, there is an inequality in access to outpatient services in the elderly. The reasons for not using outpatient services and dissatisfaction with these services should be seriously considered by health policy makers.
Type of Study: Research |
Subject:
Geriatric
Received: 2020/02/20 | Accepted: 2020/06/08 | Published: 2021/01/01
Received: 2020/02/20 | Accepted: 2020/06/08 | Published: 2021/01/01
References
1. Yavari K, B.M., Sadeghi H, Naseri AR. Economic Aspects of Ageing. Iranian Journal of Ageing. 2015; 10(1):92-105. (in Persian).
2. Mirzaie M, D.S., Babapour M. Population Aging in Iran and Rising Health Care Costs. Iranian Journal of Ageing. 2017; 12(2):156-169. http://dx.doi.org/10.21859/sija-1202156. (in Persian). [DOI:10.21859/sija-1202156]
3. Bravo, J., World population ageing report New York: United Nations, Department of Economic and Social Affairs. Relatorio de Estagio apresentado a. 2013.
4. Nikookar, R., et al., Assessing the Duration of Unnecessary Hospitalization and Expenses in Older Individuals Suffering From Cerebral Vascular Accident in the Chronic Care Unit. Iranian Journal of Ageing, 2015. 10(2): p. 180-187.
5. Culyer, A.J., The dictionary of health economics.2010: Edward Elgar Publishing. [DOI:10.4337/9781849806626]
6. Norheim O F, A.Y., The ideal of equal health revisited: definitions and measures of inequity in health should be better integrated with theories of distributive justice. . International Journal for Equity in Health. 2009 [DOI:10.1186/1475-9276-8-40] [PMID] [PMCID]
8. Pavot W, E.D., The Satisfaction With Life Scale and the emerging construct of life satisfaction. The Journal of Positive Psychology, 2008. 3(2): p. 52-137. [DOI:10.1080/17439760701756946]
9. Soltani M, S.S., Mohammadi F, Ghaffari Sh, Khosravi A, Gohari M. Elderly, Duration of Hospital and Hospital Costs Case Study in Milad Hospital, Tehran, 2008 . Iranian seniority journals 2011: 6 (23): 58-65.
10. Schofield DJ, E.A., Demographic Change and the Future Demand for Public Hospital Care in Australia, 2005 to 2050. Aust Health Rev, 2006. 30(4): p. 507-15. doi.org/10.1071/AH060507. [DOI:10.1071/AH060507] [PMID]
11. Holtz C. Global Health Care: Issues and Policies. 2th ed. Massachusetts, U.S.J.B.L., Global Health Care: Issues and Policies. 2th ed. Massachusetts, United States: Jones & Bartlett Learning. 2013.
12. Pourreza A, K.N., Health Economics and Elderly. Salmand: Iranian Journal of Ageing, 2007. 1(2): p. 8-7.
13. Yahyavi Dizaj J, Tajvar M., Mohammadzadeh Y, Marioryad H. The Effect of the Presence of an Elderly Member on Health Care Costs of Iranian Households. Salmand: Iranian Journal of Ageing. 2020; 14 (4) :462-477.
14. Pourreza A KR, A.M., Sari AA, Rahimi A, Tal A. Behavior and its influencing factors in search of the inhabitants of Tehran. J School Public Health Inst Public Health Res 2009; 7: 1- 13. (Persian).
15. Saberian M, H.A., Ghorbani R. Study of the mental status of the elderly and its relationship with leisure time activities. 2004. ( in Persian).
16. Abbasali Keshtkar, M.R., Hamid Souri, Cyrus Etemad,, Is the relationship between individual and family levels different from socioeconomic status? Analysis of the findings of the third stage of the multicentre study of osteoporosis in Iran. Majid Koomesh Autumn 2013. 17(1).
17. Borhaninejad V, N.A., Nabavi H, Rashedi V, The utilization of health services and its influences among elderly people in Kerman. Yazdi-Feyzabadi V. -2014. JNKUMS, 2015. 7(2): p. 229-240. [DOI:10.29252/jnkums.7.2.229]
18. Gholami M, N.A.A., Maleki MR. The Relation between Social Determinant of Health with Access to Health Services in Gonbad kavoos. Community Health 2016; 3(1): 54-65. (in Persian).
19. Tajik F, F.M., Rejaliyan F, Determining the Socio-Economic Inequalities in Health Services Utilization among Ischemic Heart Disease Patients; Case of Falavarjan City, Health Research Journal 2016; 2(1): 9-16. (in Persian). [DOI:10.18869/acadpub.hrjbaq.2.1.9]
20. Costa MF, C.S., Comprehensive health care of the elderly in the Family Health Program: vision of health professionals. Revista da Escola de Enfermagem da USP, 2010. 44(2): p. 437-44. doi.org/10.1590/S0080-62342010000200028.
21. Ghadamgahi, H.B.N., Kian Mohammadi, Farahnaz jandaqhi, Jafar, Stauts and determiants of health services utilization among elderly rural hubitants in the Iraninan population. Koomesh. 20; 4: p. 779-785.
22. Safari, F.N., Aniseh Ghalandari, behafarid. The effect of Socio economic factors and unmet needs on outpatient services in Iran.2019. Journal of Health Administration.22;1;91-102.
23. Rezapoor A, R.Y., Ebadi Fard Azar F, Ghazanfari S, Mirzaei S, Sarabi Asiabar A. Effective Factors on Utilization and Access to Health Care: A Population-Based Study in Kerman. journal of Health Administration 2015; 18(60). .
24. P, B., Health disparities and health equity: concepts and measurement. Annu Rev Public Health, 2006. 27: p. 167-194. [DOI:10.1146/annurev.publhealth.27.021405.102103] [PMID]
25. Madyaningrum E, C.Y., Chuang K Y. Factors associated with the use of outpatient services among the elderly in Indonesia. BMC Health Services Research (2018) 18:707
https://doi.org/10.1186/s12913-018-3512-0 [DOI:10.1186/s12913-018-3512-0.] [PMID] [PMCID]
26. George PP, H.B., De Castro Molina JA, Wong LY, Wei Lin NC, Cheah JT. Self-reported chronic diseases and health status and health service utilization--results from a community health survey in Singapore. Int J Equity Health. 2012;11:44. [DOI:10.1186/1475-9276-11-44] [PMID] [PMCID]
27. Ng N, H.M., Santosa A, Byass P, Wilopo SA, Wall S. Is self-rated health an independent index for mortality among older people in Indonesia? PLoS One. 2012;7(4):e35308. [DOI:10.1371/journal.pone.0035308] [PMID] [PMCID]
28. Mousavi N , Q.S.H.G.f.t.E.T., Association Publications.
29. Nooraiee Motlagh S, S.M.A., Barooni M. Determining Factors related to health services utilization. Razi Journal of Medical Sciences. 21.2O15. (in Persian).
30. Pourreza A, K.R., Arab M, Sari AA, Rahimi A, Tal A, Behavior and its influencing factors in search of the inhabitants of Tehran. Journal of the School of Public Health and Institute of Public Health Research, 2009. 7(2): p. 1-13. (in Persian).
31. Joulaei H, B.A.R., Sayadi M, Morady F. Slums' access to and coverage of primary health care services: a cross-sectional study in shiraz, a metropolis in southern Iran.Iran j Med Sci)2014)mar;39(2suppl):184-9.
32. Aliakbari Saba R, S.M., Utilization of health services in the country of Iran, . Journal of Amar, 2015. 16: p. 9-16. (in Persian).
33. Wagstaff A, P.P., van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33(5):545-57. PMID: 1962226. [DOI:10.1016/0277-9536(91)90212-U]
34. Park JM, H.s.a.h.s.u.i.e.K., International Journal for Equity in Health 2014, 13:73. [DOI:10.1186/s12939-014-0073-7] [PMID] [PMCID]
35. Ghadamgahi H, N.K., The Status of Health Services and Its Effective Factors in the Elderly Rural of Semnan in 1395. 2012. 20(4).
36. Bayati M, A.R., Kavosi Z, Socio-economic determinants of health in the western Pacific: A combined data analysis. Social Welfare Quarterly. 12(47).
37. Richard J, J.F., Patricia A, John V, Patterns of Older Americans' Health Care Utilization Over Time, American Journal of Public Health 2013; 103( 7):1314-1324. [DOI:10.2105/AJPH.2012.301124] [PMID] [PMCID]
38. Ferry GA, D.S., Mbaruku G, Freedman LP, Kruk ME. Equity of inpatient health care in rural Tanzania: a population- and facility-based survey. Int J Equity Health. 2012;11:7. DOI: 10.1186/1475- 9276-11-7 PMID: 22333044. [DOI:10.1186/1475-9276-11-7] [PMID] [PMCID]
39. Kim CW, L.S., Hong SC. Equity in utilization of cancer inpatient services by income classes. Health Policy. 2005;72(2):187-200. DOI: 10.1016/j.healthpol.2004.03.009 PMID: 15802154. [DOI:10.1016/j.healthpol.2004.03.009] [PMID]
40. Onwujekwe O, O.C., Uzochukwu B, Hanson K. Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers. International Journal for Equity in Health.2015;10(1). [DOI:10.1186/1475-9276-10-50] [PMID] [PMCID]
41. Lorant V, B.B., Humblet P, Deliege D. Equity in prevention and health care. J Epidemiol Community Health. 2002; 56(7):510-6. PMID: 12080158. [DOI:10.1136/jech.56.7.510] [PMID] [PMCID]
42. Hosseinpoor AR1, N.M., Alavian SM, Speybroeck N, Jamshidi H, Vega J.Determinants of seeking needed outpatient care in Iran: results from a national health services utilization survey.Arch Iran Med. Volume10,Number4,2007:439 -445.
43. Hassanzadeh J, M.A., Eshrati B: Determinants of Inequity in Health Care Services Utilization in Markazi Province of Iran,Iran Red Crescent Med J. . 2013 May; 15(5): 363-370. [DOI:10.5812/ircmj.3525] [PMID] [PMCID]
44. Louvison, M.و.P.L., Marilia Cristina ; Lebrao, MLLebrao, Maria Luciaو Inequalities in access to health care services and utilization for the elderly in Sao Paulo, REVISTA DE SAUDE PUBLICA, Volume: 42,Issue: 4 Pages: 733-740 (2008). [DOI:10.1590/S0034-89102008000400021] [PMID]
45. Nie, J.X.W., Li; Tracy, C. Shawn.Health care service utilization among the elderly: findings from the Study to Understand the Chronic Condition Experience of the Elderly and the Disabled Journal Of Evaluation In Clinical Practice Volume: 14 Issue: 6 Pages: 1044-1049 Published: DEC 2008. [DOI:10.1111/j.1365-2753.2008.00952.x] [PMID]
46. Morishita L, B.C., Boult L, et al. Satisfaction with outpatient geriatric Evaluation and management (GEM). GERONTOLOGIST. 1998. Jun; 38(3).PP.15-21. [DOI:10.1093/geront/38.3.303] [PMID]
47. N, H., study A IN viewpoints OF old people about offer of some health services for OLD people (Thesis). Isfahan: Isfahan University of medical sciences, 2003.
48. Ali Keshtkaran, et al., Satisfaction of outpatients referring to teaching hospitals clinics in Shiraz, 2009. Health Monitor Journal of the Iranian Institute for Health Sciences Research, 2012. 11(4): p. 459-465.
49. Bakhtiari, A. and A. Hadj-Hasani, The effective parameters on the patient satisfaction level of the referral patients to the out-patient physiotherapy clinics of the Semnan medical sciences university (second half of the year 2001). Koomesh, 2005. 6(2): p. 167-174.
50. Jackson, J.L., J. Chamberlin, and K. Kroenke, Predictors of patient satisfaction. Social science & medicine, 2001. 52(4): p. 609-620. [DOI:10.1016/S0277-9536(00)00164-7]
51. BODUR, S., Y.E. Özdemir, and F. Kara, Outpatient satisfaction with health centers in urban areas. Turkish Journal of Medical Sciences, 2002. 32(5): p. 409-414.
52. Net, N., Patient Satisfaction toward health services at the out-patient department clinic of wangnumyen community hospital, Sakaeo province. Mahidol University, 2007.
53. Amerion, A., et al., Inpatient and outpatient satisfaction of a military hospital. Journal Mil Med, 2009. 11(1): p. 37-44.
54. Nobile, C., et al., Satisfaction with care in outpatient clinics in Italy. 2004.
55. SEYF, R.M. and M.A. SHAHIDZADEH, Patient satisfaction: A study of Hamedan teaching and general hospitals. 2006.
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