未满足的医疗保健需求
——欧洲老年人的一个严重问题？
原文作者 韦罗妮卡·krůtilovaacute;a,*
单位 布尔诺阿蒙德尔大学商业和经济学院
摘要：未满足的需求在卫生保健系统里被认为是的一个不良特征。该论文分析了欧洲老年人未得到满足的卫生保健需求。使用了欧洲健康、老龄化和退休调查的数据。采用描述性分析的方法。结果显示，这在爱沙尼亚和意大利尤为严重。需求未得到满足的老年人健康状况更差，患慢性病的人数更多，他们面临更高的医疗负担。其中健康状况最差的是低收入的老年人。
关键词：老年人；未满足的需求；医疗保健；现金支付；分享
1.介绍
卫生保健需求得不到满足是现代卫生保健和社会系统的一个不良特征，也是卫生保健政策关注的一个主题。获得医疗保健被认为是发达国家许多医疗保健系统的基本原则之一(European Commission, 2010; Koolman, 2007; Terraneo, 2014; Devaux, 2013)。
从获得卫生保健的横向公平的角度来看，所有个人都应该根据他们的(健康)需要获得理想的保健，而不论年龄、种族、性别、教育等特征如何(Whitehead, 1991; Gutmann, 1981)。获得医疗保健受到各种因素的影响。一般来说，社会人口背景、社会网络、健康和经济起着至关重要的作用(Tur-Sinai amp; Litwin，2015)。
关于保健消费的决定受社会人口特征的影响，如年龄、性别、教育、家庭成员人数或居住地。未得到满足的保健需求可能是由一些简单的因素造成的，如对保健系统的不信任、对治疗的恐惧、对自身健康或网络的态度或保健提供者的质量。健康状况恶化和疾病累积尤其会导致需求得不到满足。另一个重要因素是卫生保健融资(卫生保健提供者的资源有限会导致等待时间)和自付费用水平。自付费被认为是最倒退的卫生保健支出方式(Saltman amp; Figueras, 1997; Votilde;rk et al., 2010; Hopkins amp; Cumming, 2001; Arhin-Tenkorang, 2001; Yardima et al., 2010; Xu et al., 2009)。如果支出过高，给家庭预算造成沉重负担，个人可以决定推迟或放弃医疗保健消费。此外，无论收入和健康状况是否正相关，低收入消费者受高额自付费用的影响最大(Hopkins amp; Cumming，2001)。
根据一些研究，产生未满足需求的最重要原因似乎是医疗保健费用和等待时间 (Koolman, 2007; Tur-Sinai amp; Litwin, 2015)。这两个原因都很严重且值得关注。然而，本文只关注由卫生保健费用(自付费)引起的未满足的需求。必须支付医疗保健价格似乎是引起未满足的需求产生的一个原因。无论自付费用的水平是否危及家庭维持其惯常生活水平的能力(Berki，1986)，它都可能导致家庭陷入贫困和/或推迟或放弃获得保健服务。在许多研究中，老年人被认为是健康状态最差的群体(尤其是65岁以上的人)( Hong amp; Kim, 2000; Yardima et al., 2010; De Graeve et al., 2006; Habicht et al., 2006; Klavus amp; Kapiainen, 2008; Economou, 2010; Xu et al., 2009)。与有年轻和经济活跃成员的家庭相比，老年人面临更高的自付费用，花费更高的收入份额(Berki, 1985; Rasell et al., 1994; Wyszewianski, 1986)。
本文关注老年人未满足的需求。因为年龄、较高的发病率、慢性病的存在和较低的收入(退休年龄不从事经济活动的结果)等特征的结合决定了老年人是最健康状态最差的群体。
本文的目的是评估选定的欧洲国家中老年人未满足的卫生保健需求的程度，并探讨未满足卫生保健需求的老年人的特征。
2.数据和方法
2.1使用的数据
本文使用了第五次欧洲健康、老龄化和退休调查的数据(Bouml;rsch- Supan, 2015)。SHARE是一项针对50岁及以上人群的独特调查。SHARE包含伴随和影响老龄化进程的经济、社会和健康因素的微观面板数据(Bouml;rsch-Supan et al., 2013)。在第5次中，覆盖了14个欧洲国家(奥地利、比利时、捷克共和国、丹麦、爱沙尼亚、法国、德国、意大利、荷兰、斯洛文尼亚、西班牙、瑞典、瑞士、卢森堡)。除其他外，第五次还整合了一个广泛的医疗保健模块，允许在两个领域进行国际比较:医疗保健利用(过去12个月)，包括未满足的需求，以及医疗保险覆盖范围和自付费用(Malter amp; Bouml;rsch-Supan, 2015)。目标人口是1962年或更早出生的人，以及1962年或更早出生的人的配偶/伴侣(至少有一名成员属于个人目标人口的所有家庭)。以下受访者不包括在内:不会说该国任何官方语言的人，在整个实地调查期间被监禁、住院或不在该国的人。为了收集数据，使用了所谓的CAPI(计算机辅助个人访谈)。第五次调查于2013年进行，实地工作于2013年11月完成。该调查基于覆盖全部人口的概率样本。Bouml;rsch- Supan et al. (2013) 讨论了与份额调查有关方面的所有方法，Malter and Bouml;rsch-Supan (2015)讨论了与第五次有关的特殊方法问题。
2.2方法
研究的主题是作为受访者保健需求未得到满足的主观感受。在分析中，62949名50岁及以上的人被纳入调查。首先，在所有包括的国家进行未被满足的卫生保健需求调查。SHARE包括三个变量，能够检查与经济负担相关的未满足的保健需求:
bull;未满足的就医需求(在过去的12个月中，您是否有过因费用问题而无法就医的经历？)
bull;未满足的牙医需求(在过去12个月中，为了帮助您降低生活成本，您是否推迟了去看牙医？)
bull;未满足的眼镜需求(在过去12个月中，为了帮助您降低生活成本，您是否因为买不起新眼镜而没有或没有更换所需的眼镜？)
3.结果
表1列出了所有三种类型的未满足需求和累计未满足需求(至少有一种类型的未满足需求由受访者申报)。
需求未得到满足的老年人比例因国家而异，从丹麦的5.3%到爱沙尼亚的45.2%。各类未满足需求中老年人所占比例最高的是爱沙尼亚(45.2%)。未得到满足的老年人数量第二高的是意大利，无论是以累计方式(28.8%)还是根据每种未满足的需求来看都是如此。西班牙排在第三位，22.1%的老年人声称至少有一种需求未得到满足(特别是由于对牙医和眼镜的需求未得到满足)。其他国家的老年人放弃护理的情况要少得多。未满足需求类型之间的差异是显而易见的。总的来说，老年人尤其推迟或被限制看牙医。很大一部分老年人也会推迟更换眼镜，看医生是最少被放弃的。老年人比例最低的是丹麦(0.5%)，其次是瑞典(不到1%的老年人)。斯洛文尼亚、瑞士、荷兰和奥地利的老年人比例也很低，在1.1%至1.6%之间。爱沙尼亚(17%)和意大利(10.7%)的老年人比例令人担忧。在被观察的欧洲国家中，平均有16.4%的老年人面临未满足的需求。这一数值表明，只关注需求未得到满足的老年人是可信的。
表1.展示国家保健需求未得到满足的老年人比例
|
国家 |
未满足的需求 |
||||||||
|
医生 |
牙医 |
眼镜 |
总数 |
||||||
|
丹麦 |
0.5% |
4.0% |
2.6% |
5.3% |
|||||
|
瑞士 |
1.3% |
3.3% |
3.3% |
6.1% |
|||||
|
奥地利 |
1.6% |
4.2% |
4.1% |
7.3% |
|||||
|
瑞典 |
0.9% |
4.4% |
4.3% |
7.6% |
|||||
|
卢森堡 |
3.0% |
4.0% |
4.4% |
7.7% |
|||||
|
荷兰 |
1.5% |
4.2% |
5.5% |
8.2% |
|||||
|
比利时 |
3.1% |
5.3% |
5.5% |
9.6% |
|||||
|
捷克共和国 |
3.9% |
7.3% |
5.9% |
11.9% |
|||||
|
德国 |
4.3% |
6.0% |
7.5% |
12.6% |
|||||
|
斯洛文尼亚 |
1.1% |
5.2% |
11.6% |
14.0% |
|||||
|
法国 |
4.0% |
8.6% |
8.5%% |
14.3% |
|||||
|
西班牙 |
3.9% |
16. 5% |
13.4% |
22.1% |
|||||
|
意大利 |
10.7% |
20.6% |
17.7% |
28.8% |
|||||
|
爱沙尼亚 |
17.0% |
35.1% |
25.9% |
45.2% 剩余内容已隐藏，支付完成后下载完整资料 Available online at www.sciencedirect.com ScienceDirect Procedia - Social and Behavioral Sciences 220 (2016) 217 – 225 19th International Conference Enterprise and Competitive Environment 2016, ECE 2016, 10–11 March 2016, Brno, Czech Republic Unmet Need For Health Care – A Serious Issue for European Elderly? Veronika Krůtilovaacute;a,* aMendel University in Brno, Faculty of Business and Economics, ZemČdČlskaacute; 1, Brno, 61300, Czech Republic
copy; 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of the organizing committee of ECE 2016 copy; 2016 The Authors. Published by Elsevier Ltd. Peer-review under responsibility of the organizing committee of ECE 2016. Abstract Unmet need is found as an undesirable feature of health care systems. The paper analyses unmet health care need among European elderly. The data from the Survey of Health, Ageing and Retirement in Europe is used. The methods of descriptive analyses are applied. Results showed that access to health care is not equal; unmet need exists and is serious in Estonia and Italy especially. The elderly with unmet need have worse health and suffer from a higher number of chronic diseases. They face higher health care burden. The most vulnerable are older elderly with a low income. Keywords: elderly; unmet need; health care; out-of-pocket payments; SHARE
IntroductionUnmet need for health care is an undesirable feature of modern health care and social systems and it is a subject of interest of health care policies. Access to health care is recognized as one of the basic principles of many health care systems in developed countries (European Commission, 2010; Koolman, 2007; Terraneo, 2014; Devaux, 2013). From the point of view of horizontal equity in access to health care all individuals should have access to desirable care according to their (health) need regardless of characteristics such as such as age, race, gender, education (Whitehead, 1991; Gutmann, 1981). Access to health care is affected by various factors. In general, sociodemographic background, social network, health and economics play a crucial role (Tur-Sinai amp; Litwin, 2015). The decision about
* Corresponding author. Tel.: 420545132556; fax: 420545132645. E-mail address: veronika.krutilova@mendelu.cz 1877-0428 copy; 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer-review under responsibility of the organizing committee of ECE 2016 doi:10.1016/j.sbspro.2016.05.487 consumption of health care is influenced by sociodemographic characteristics such as age, gender, education, number of household members or place of living. Unmet health care need can be caused by simple factors such as distrust of health care system, fear from treatment, attitude to own health or network or quality of health care providers. Worse health status and accumulation of diseases can lead to unmet need in particular. Other important factor is health care financing (limited resources for health care providers can cause waiting times) and a level of out-of-pocket payments. Out-of-pocket payments are considered as the most regressive way of spending for health care (Saltman amp; Figueras, 1997; Votilde;rk et al., 2010; Hopkins amp; Cumming, 2001; Arhin-Tenkorang, 2001; Yardima et al., 2010; Xu et al., 2009). If the spending is too high and causes a high burden for household budgets, individuals can decide to postpone or forgone health care consumption. Moreover, whether income and health status are positively correlated, low-income consumers are influenced by high out-of-pocket payments the most (Hopkins amp; Cumming, 2001). With reference to some studies health care cost and waiting times appeared to be the most important reason for unmet need (Koolman, 2007; Tur-Sinai amp; Litwin, 2015). These both reasons are serious ones and it is worth paying attention to them. Nevertheless, this paper focuses only on unmet need caused by health care costs (out-of-pocket payments). Unmet need appears as a reason of price of health care which has to be paid. Whether the level of out-of- pocket payments endangers the households ability to maintain its customary standard of living (Berki, 1986), it can result in pushing households into the poverty and/or postponing or forgoing access to health care. In a number of studies the elderly were identified as the most vulnerable group (especially people over age 65) (Hong amp; Kim, 2000; Yardima et al., 2010; De Graeve et al., 2006; Habicht et al., 2006; Klavus amp; Kapiainen, 2008; Economou, 2010; Xu et al., 2009). The elderly face higher out-of-pocket payments and spend a higher share of their income than households with younger and economically active members (Berki, 1985; Rasell et al., 1994; Wyszewianski, 1986). This paper focuses on unmet need of the elderly. The rationale is that a combination of characteristics such as age, higher morbidity, presence of chronic illnesses and a lower income (as a result of economic inactivity in retirement age) determine the elderly as the most vulnerable group. The objective of the paper is to evaluate the extent of unmet need for health care among the elderly in selected European countries and to explore characteristics of the elderly with unmet need for health care. Data and methods
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