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. ,
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In the first model, the need for outpatient services had a significant relationship with gender, age, place of residence, marital status, literacy, basic insurance and owning a car (P<0.05). The second model showed that, although females, older ones, villagers and the unmarried were more in need of outpatient services, their referrals to receive the services were not more than those of other groups. Moreover, while the illiterate needed more health services, but the number of literate subjects referred to receive services was significantly higher.
Lack of basic insurance, supplementary insurance, and a personal car had a significant impact on reducing the number of elderly people referred to receive outpatient services. In the third model, considering that 98% of the subjects were able to receive the needed services, their characteristics did not show a relationship with the health service utilization. In the fourth model, there was a significant relationship between the satisfaction level and the age of >70 years, place of residence, marital status and literacy such that the elderly over 70 years of old, living in rural areas and unmarried had significantly less satisfaction than others.
4. Conclusion
Although the use of health services should be based on the need for these services, the present study showed that the socio-economic status of older people is an important determinant of access to and use of outpatient health services by them. The most common reasons for referring to receive outpatient services included inability to pay the expenses, self-treatment, and lack of health insurance. Therefore, it is expected that by taking measures to improve the living conditions of the older people, increasing their health insurance coverage, integration of insurance organizations, and promoting the Family Physician Program, the use of outpatient services by the elderly can be increased. It is necessary to identify the effective variables and take measures to improve their status. The results of this study can be helpful with reforming the health system and how resources are allocated to this age group.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.SPH.REC.1397.4982).
Funding
This study was extracted from Msc. thesis of the last author at Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran. Also, this study was supported by Tehran University of Medical Sciences.
Authors' contributions
All authors contributed equally in preparing this paper.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank School of Public Health and Statistics Research Institute of Iran for their cooperation.
References
Full-Text: (3631 Views)
1. Introduction
Due to the rapid growth of Iran’s elderly population, the demand for health services and the rate of health costs are increasing in this country. The elderly are major consumers of health services and are put a heavy financial burden on the health system and insurance organizations [1, 7,8,9,10]. In order to be prepared to respond to the growing health needs of the elderly and to face the challenges ahead, it is necessary to be aware of the status and patterns of need and utilization for health services in the elderly to allocate resources in this area. Health service utilization studies help to identify related underlying factors and facilitators or barriers to utilization and to determine the appropriateness of the volume and quality of provided care [14, 15]. This study aims to investigate the pattern of outpatient health service utilization in the elderly in Iran, their level of satisfaction with the services, and the underlying factors related to the utilization and satisfaction.
2. Methods & Materials
This is a secondary quantitative study with cross-sectional design using the primary data of the “National Study of Health Service Utilization” conducted in 2015 by the National Institute for Health Research and the Statistics Research Institute. The study population consists of all older people aged ≥60 years in Iran. Of these, 8205 were selected by three-stage random sampling method from the provinces, cities and villages. Data collection tool in this study was two structured questionnaires, one was a household questionnaire completed by the head of the household and the other was a personal questionnaire only for family members who at the time of completing the questionnaire expressed a need for outpatient services during the past two weeks. For those who received the services, a questionnaire measuring the utilization and satisfaction with the received services was completed. The raw data of this study were first entered into Excel software for data cleaning and data management, and the accuracy and consistency of the data were checked and confirmed. Due to the fact that the number of missing data was very small, the features were ignored for those samples when analyzing the data. Finally, the data were entered into SPSS17 software for statistical analysis. Descriptive statistics such as mean, frequency and percentage were used for describing data, and multilevel logistic regression analysis in four models was used to examine the factors related to the need, referral, utilization, and satisfaction for outpatient services. To show the distribution of outpatient services for the elderly in Iran, a map prepared in GIS software was used.
3. Results
In this study, out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (n=2060) benefited from outpatient services. There was a relatively high distribution among the provinces of Iran in terms of benefiting from outpatient health services compared to the need for these services. People who did not refer to receive the outpatient services despite the need for them (n=1068) were asked about the reasons for not referring. Inability to afford (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons. Overall satisfaction of 54% of service recipients was low-to-moderate; in others (46%), it was relatively high. Older, illiterate and rich people were more dissatisfied with the received services than others.
The factors related to the need for outpatient services, referring to receive the services, using the services, and satisfaction with the services are presented in Table 1 categorized into 4 models.
Due to the rapid growth of Iran’s elderly population, the demand for health services and the rate of health costs are increasing in this country. The elderly are major consumers of health services and are put a heavy financial burden on the health system and insurance organizations [1, 7,8,9,10]. In order to be prepared to respond to the growing health needs of the elderly and to face the challenges ahead, it is necessary to be aware of the status and patterns of need and utilization for health services in the elderly to allocate resources in this area. Health service utilization studies help to identify related underlying factors and facilitators or barriers to utilization and to determine the appropriateness of the volume and quality of provided care [14, 15]. This study aims to investigate the pattern of outpatient health service utilization in the elderly in Iran, their level of satisfaction with the services, and the underlying factors related to the utilization and satisfaction.
2. Methods & Materials
This is a secondary quantitative study with cross-sectional design using the primary data of the “National Study of Health Service Utilization” conducted in 2015 by the National Institute for Health Research and the Statistics Research Institute. The study population consists of all older people aged ≥60 years in Iran. Of these, 8205 were selected by three-stage random sampling method from the provinces, cities and villages. Data collection tool in this study was two structured questionnaires, one was a household questionnaire completed by the head of the household and the other was a personal questionnaire only for family members who at the time of completing the questionnaire expressed a need for outpatient services during the past two weeks. For those who received the services, a questionnaire measuring the utilization and satisfaction with the received services was completed. The raw data of this study were first entered into Excel software for data cleaning and data management, and the accuracy and consistency of the data were checked and confirmed. Due to the fact that the number of missing data was very small, the features were ignored for those samples when analyzing the data. Finally, the data were entered into SPSS17 software for statistical analysis. Descriptive statistics such as mean, frequency and percentage were used for describing data, and multilevel logistic regression analysis in four models was used to examine the factors related to the need, referral, utilization, and satisfaction for outpatient services. To show the distribution of outpatient services for the elderly in Iran, a map prepared in GIS software was used.
3. Results
In this study, out of 8205 participants, 3172 (39%) reported the need for outpatient services, of which 66% referred for services; of these, 98% (n=2060) benefited from outpatient services. There was a relatively high distribution among the provinces of Iran in terms of benefiting from outpatient health services compared to the need for these services. People who did not refer to receive the outpatient services despite the need for them (n=1068) were asked about the reasons for not referring. Inability to afford (30%), self-treatment (28%) and lack of proper insurance coverage (13%) were the most important reasons. Overall satisfaction of 54% of service recipients was low-to-moderate; in others (46%), it was relatively high. Older, illiterate and rich people were more dissatisfied with the received services than others.
The factors related to the need for outpatient services, referring to receive the services, using the services, and satisfaction with the services are presented in Table 1 categorized into 4 models.
In the first model, the need for outpatient services had a significant relationship with gender, age, place of residence, marital status, literacy, basic insurance and owning a car (P<0.05). The second model showed that, although females, older ones, villagers and the unmarried were more in need of outpatient services, their referrals to receive the services were not more than those of other groups. Moreover, while the illiterate needed more health services, but the number of literate subjects referred to receive services was significantly higher.
Lack of basic insurance, supplementary insurance, and a personal car had a significant impact on reducing the number of elderly people referred to receive outpatient services. In the third model, considering that 98% of the subjects were able to receive the needed services, their characteristics did not show a relationship with the health service utilization. In the fourth model, there was a significant relationship between the satisfaction level and the age of >70 years, place of residence, marital status and literacy such that the elderly over 70 years of old, living in rural areas and unmarried had significantly less satisfaction than others.
4. Conclusion
Although the use of health services should be based on the need for these services, the present study showed that the socio-economic status of older people is an important determinant of access to and use of outpatient health services by them. The most common reasons for referring to receive outpatient services included inability to pay the expenses, self-treatment, and lack of health insurance. Therefore, it is expected that by taking measures to improve the living conditions of the older people, increasing their health insurance coverage, integration of insurance organizations, and promoting the Family Physician Program, the use of outpatient services by the elderly can be increased. It is necessary to identify the effective variables and take measures to improve their status. The results of this study can be helpful with reforming the health system and how resources are allocated to this age group.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Tehran University of Medical Sciences (Code: IR.TUMS.SPH.REC.1397.4982).
Funding
This study was extracted from Msc. thesis of the last author at Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran. Also, this study was supported by Tehran University of Medical Sciences.
Authors' contributions
All authors contributed equally in preparing this paper.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank School of Public Health and Statistics Research Institute of Iran for their cooperation.
References
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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
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