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Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare

Author

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  • Tetsuji Yamada

    (Department of Economics, Center for Children and Childhood Studies, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA)

  • Chia-Ching Chen

    (Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, 95 Grasslands Rd., Valhalla, NY 10595, USA
    These authors contributed equally to this work.)

  • Chiyoe Murata

    (Department of Social Science, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka cho, Obu-shi, Aichi-ken, 474-8511 Japan
    These authors contributed equally to this work.)

  • Hiroshi Hirai

    (Department of Civil Environmental Engineering, Iwate University, 4-3-5, Ueda, Morioka-shi, Iwate-ken, 020-8551 Japan
    These authors contributed equally to this work.)

  • Toshiyuki Ojima

    (Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu-shi, Shizuoka-ken, 431-3192 Japan
    These authors contributed equally to this work.)

  • Katsunori Kondo

    (Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba-ken, 260-8670 Japan
    These authors contributed equally to this work.)

  • Joseph R. Harris III

    (Department of Public Policy and Administration, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA
    These authors contributed equally to this work.)

Abstract

The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality.

Suggested Citation

  • Tetsuji Yamada & Chia-Ching Chen & Chiyoe Murata & Hiroshi Hirai & Toshiyuki Ojima & Katsunori Kondo & Joseph R. Harris III, 2015. "Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare," IJERPH, MDPI, vol. 12(2), pages 1-28, February.
    • Handle: RePEc:gam:jijerp:v:12:y:2015:i:2:p:1745-1772:d:45442
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    References listed on IDEAS

    as
    1. Lima-Costa, M.F. & De Oliveira, C. & MacInko, J. & Marmot, M., 2012. "Socioeconomic inequalities in health in older adults in Brazil and England," American Journal of Public Health, American Public Health Association, vol. 102(8), pages 1535-1541.
    2. Kanika Kapur & Geoffrey F. Joyce & José J. Escarce & Krista A. Van Vorst, 2000. "Visits to primary care physicians and to specialists under gatekeeper and point-of-service arrangements," Open Access publications 10197/278, School of Economics, University College Dublin.
    3. Ulf‐ G. Gerdtham, 1997. "Equity in Health Care Utilization: Further Tests Based on Hurdle Models and Swedish Micro Data," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 303-319, May.
    4. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, June.
    5. Monica Oliveira, 2004. "Modelling demand and supply influences on utilization: A flow demand model to predict hospital utilization at the small area level," Applied Economics, Taylor & Francis Journals, vol. 36(20), pages 2237-2251.
    6. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    7. Lasser, K.E. & Himmelstein, D.U. & Woolhandler, S., 2006. "Access to care, health status, and health disparities in the United States and Canada: Results of a Cross-National Population Based Survey," American Journal of Public Health, American Public Health Association, vol. 96(7), pages 1300-1307.
    8. Voigt, Kristin, 2012. "Incentives, health promotion and equality," Health Economics, Policy and Law, Cambridge University Press, vol. 7(3), pages 263-283, July.
    9. Mark Berger & Jodi Messer, 2002. "Public financing of health expenditures, insurance, and health outcomes," Applied Economics, Taylor & Francis Journals, vol. 34(17), pages 2105-2113.
    10. Kakwani, Nanak & Wagstaff, Adam & van Doorslaer, Eddy, 1997. "Socioeconomic inequalities in health: Measurement, computation, and statistical inference," Journal of Econometrics, Elsevier, vol. 77(1), pages 87-103, March.
    11. Doorslaer, Eddy van & Jones, Andrew M., 2003. "Inequalities in self-reported health: validation of a new approach to measurement," Journal of Health Economics, Elsevier, vol. 22(1), pages 61-87, January.
    12. Kroneman, Madelon W. & Maarse, Hans & Zee, Jouke van der, 2006. "Direct access in primary care and patient satisfaction: A European study," Health Policy, Elsevier, vol. 76(1), pages 72-79, March.
    13. Herrera-Espiñeira, Carmen & Rodríguez del Aguila, Maria del Mar & Rodríguez del Castillo, Mercedes & Valdivia, Antonia Fernández & Sánchez, Isabel Reyes, 2009. "Relationship between anxiety level of patients and their satisfaction with different aspects of healthcare," Health Policy, Elsevier, vol. 89(1), pages 37-45, January.
    14. Zuckerman, S. & Haley, J. & Roubideaux, Y. & Lillie-Blanton, M., 2004. "Health Service Access, Use, and Insurance Coverage among American Indians/Alaska Natives and Whites: What Role Does the Indian Health Service Play?," American Journal of Public Health, American Public Health Association, vol. 94(1), pages 53-59.
    15. Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
    16. repec:mpr:mprres:6406 is not listed on IDEAS
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    Cited by:

    1. Tao Zhang & Chaojie Liu & Ziling Ni, 2019. "Association of Access to Healthcare with Self-Assessed Health and Quality of Life among Old Adults with Chronic Disease in China: Urban Versus Rural Populations," IJERPH, MDPI, vol. 16(14), pages 1-14, July.
    2. Mohanty, Sanjay K. & Khan, Junaid & Maiti, Suraj & Kämpfen, Fabrice & Maurer, Jürgen & O'Donnell, Owen, 2025. "Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: Analysis of nationally representative data," Social Science & Medicine, Elsevier, vol. 364(C).
    3. Hao Dong & Zhenghui Li & Pierre Failler, 2020. "The Impact of Business Cycle on Health Financing: Subsidized, Voluntary and Out-of-Pocket Health Spending," IJERPH, MDPI, vol. 17(6), pages 1-24, March.
    4. Jens Hoebel & Alexander Rommel & Sara Lena Schröder & Judith Fuchs & Enno Nowossadeck & Thomas Lampert, 2017. "Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany," IJERPH, MDPI, vol. 14(10), pages 1-18, September.

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