ÖDEME GÜÇLÜĞÜNE BAĞLI KARŞILANAMAYAN TIBBİ BAKIM İHTİYACI

Yıl 2022, Cilt: 9 Sayı: 4, 309 - 316, 01.12.2022

Melek Terzi Mehmet Nurullah Kurutkan Dilek Şahin Oğuz Kara

https://doi.org/10.52880/sagakaderg.1074505

Öz

Amaç: Bu çalışmanın amacı kronik hastalıkların ve sosyo-ekonomik faktörlerin tıbbi bakımda ödeme güçlüğü üzerindeki etkilerini belirlemektir.
Yöntem: Analizde kullanılan değişkenler 2016 yılına ait “TÜİK Sağlık Araştırması” mikro veri setinden elde edilmiştir. Kronik hastalığa ait verilerin ve sosyo-ekonomik değişkenlerin tıbbi bakımda ödeme güçlüğünü etkileme derecesini tespit etmek için üç model kurulmuştur. Modellerin analizinde Binary Logit Regresyon analizi kullanılmıştır.
Bulgular: Tıbbi bakımda ödeme güçlüğü açısından yaş, eğitim, hane geliri, tedavi masrafı SGK, tedavi masrafı GSS, tedavi masrafı diğer, çalışmama nedeni, iş sürekliliği, çalışma şekli, genel sağlık durumu, 6 aydan uzun hastalık durumu, yaşamsal faaliyet kısıtlama, astım, bronşit, koroner kalp yetmezliği, arthosis, bel bölgesi, boyun bölgesi, alerji, karaciğer yetmezliği, böbrek, depresyon, diğer kronik hastalıklar, gözlük kullanma, bedensel ağrı durumu, ağrının hayatı engellemesi, bunalım, değersiz hissetme, son 12 ay yataklı hizmet alma, son 12 ay günübirlik hizmet alma, kendi kararıyla ilaç kullanımı, kolestrol ölçülme, kan şekeri ölçülme, gaitada gizli kan testi ölçülme, gecikme randevu, ödeme güçlüğü diş bakım, ödeme güçlüğü ilaç, ödeme güçlüğü ruh tedavisi, tütün kullanım durumu ve tütün dumanı maruziyeti etkili olmuştur (p<0,05). Cohen d’ye göre tıbbi bakımda ödeme güçlüğünde etki gücü en kuvvetli olan gruplar ise diş bakımı, ilaç ve ruh tedavisinde ödeme güçlüğü, ulaşımdan dolayı gecikme, bunalım ve kronik bronşittir (E.B. > 0,8).
Sonuç: Araştırma sonuçlarına göre kronik hastalıkların ve sosyo-ekonomik değişkenlerin tıbbi bakım ödeme güçlüğünde etkili olduğu belirlenmiştir. Politika yapıcılar, farklı kronik durumların, demografik ve ekonomik yapının karşılaştırmalı yüküne ilişkin ekonometrik modellere dayalı kanıtlardan faydalanabilir.

Anahtar Kelimeler

Karşılanmayan Tıbbi Bakım, Ödeme Güçlüğü, Kronik Hastalıklar, Ulusal Sağlık Araştırması

UNMET MEDICAL CARE NEEDS DUE TO PAYMENT DIFFICULTY

Öz

Objective: This study aims to determine the effects of chronic diseases and socio-economic factors on payment difficulty in medical care.
Methods: The variables used in the analysis were obtained from the “2016 TURKSTAT Health Survey” micro data set. Three models were established to determine the degree of chronic disease data and socio-economic variables affecting the payment difficulty in medical care. Binary Logit Regression analysis was used to analyze the models.
Findings: In terms of payment difficulty in medical care; age, education, household income, social security institution (SGK) treatment cost, general health insurance (GSS) treatment cost, other treatment cost, reason for not working, work continuity, working method, overall health status, being sick longer than 6 months, vital activity restriction, asthma, bronchitis, coronary heart failure, arthrosis, waist and neck disorders, allergy, liver failure, kidney disease, depression, other chronic diseases, wearing glasses, physical pain state, pain preventing life, feeling worthless, receiving bed service for the last 12 months, receiving daily service for the last 12 months, drug use by his own decision, cholesterol measurement status, blood glucose measurement status, stool occult blood test measurement status, being late for appointment, payment difficulty in dental care, in drug and in spiritual treatment, tobacco use status and exposure to tobacco smoke were effective (p<0,05). According to Cohen d, the groups with the strongest effect on payment difficulty in medical care are payment difficulty in dental care, drug and spiritual treatment, delay due to transportation, depression and chronic bronchitis (E.B. > 0,8).
Conclusions: According to the results of the research, it was determined that chronic diseases and socio-economic variables are effective in the payment difficulty of medical care. Policymakers can benefit from evidence-based on econometric models of the comparative burden of different chronic conditions, demographic and economic structure.

Anahtar Kelimeler

Unmet Medical Care, Payment Difficulty, Chronic Diseases, National Health Survey

Kaynakça

• 1. WHO. WHO | What is Quality of Care and why is it important? [Internet]. WHO. World Health Organization; 2017 [cited 2019 Nov 13]. Available from: https://www.who.int/maternal_child_adolescent/topics/quality-of-care/definition/en/
• 2. Eurostat. Unmet health care needs statistics - Statistics Explained [Internet]. Eurostat. 2018 [cited 2019 Nov 5]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php/Unmet_health_care_needs_statistics#General_overview
• 3. WorldBank, WHO. World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses [Internet]. 2019 [cited 2019 Nov 13]. Available from: https://www.who.int/news-room/detail/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
• 4. Kelland K. Half of world’s people can’t get basic health services: WHO - Reuters. Reuters [Internet]. 2017 [cited 2019 Nov 13]; Available from: https://www.reuters.com/article/us-health-who-access/half-of-worlds-people-cant-get-basic-health-services-who-idUSKBN1E71NK
• 5. Carr, W., & Wolfe, S. (1976). Unmet needs as sociomedical indicators. International Journal of Health Services, 6(3), 417–430.
• 6. Aday, L. A., & Andersen, R. (1974). A Framework for the Study of Access to Medical Care. Health Services Research, 9(3), 208–220.
• 7. D’Alessandro, U., Ubben, D., Hamed, K., Ceesay, S. J., Okebe, J., Taal, M., Lama, E. K., Keita, M., Koivogui, L., Nahum, A., Bojang, K., Sonko, A. A. J., Lalya, H. F., & Brabin, B. (2012). Malaria in infants aged less than six months - Is it an area of unmet medical need? Malaria Journal, 11, 400.
• 8. Stoddard, J., & Dougherty, N. (2010). Universal immunization of infants against Neisseria meningitidis: Addressing the remaining unmet medical need in the prevention of meningitis and septicemia. Human Vaccines, 6(2), 219–223.
• 9. Bennett, A. C., Rankin, K. M., & Rosenberg, D. (2012). Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs? Maternal and Child Health Journal, 16(2), 330–338.
• 10. Miller, J. E., Nugent, C. N., Gaboda, D., & Russell, L. B. (2013). Reasons for Unmet Need for Child and Family Health Services among Children with Special Health Care Needs with and without Medical Homes. PLoS ONE, 8(12), e82570.
• 11. Warfield, M. E., & Gulley, S. (2006). Unmet need and problems accessing specialty medical and related services among children with special health care needs. Maternal and Child Health Journal, 10(2), 201–216.
• 12. Charlson, M., & Peterson, J. C. (2002). Medical comorbidity and late life depression: What is known and what are the unmet needs? Biological Psychiatry, 52(3), 226–235.
• 13. Ghesquiere, A., Villanueva, C., Gardner, D., Callahan, J., Kenien, C., & Reid, C. (2015). Depression Symptoms and Unmet Need for Medical Care in Chronically Ill Older Adults Living in Traditionally Underserved Communities. The American Journal of Geriatric Psychiatry, 23(3), S112–S113.
• 14. Reeves, A., McKee, M., Mackenbach, J., Whitehead, M., & Stuckler, D. (2017). Public pensions and unmet medical need among older people: Cross-national analysis of 16 European countries, 2004-2010. Journal of Epidemiology and Community Health, 71(2), 174–180.
• 15. Pagán, J. A., & Pauly, M. V. (2006). Community-level uninsurance and the unmet medical needs of insured and uninsured adults. Health Services Research, 41(3), 788–803.
• 16. Burris, H. A. (2009). Shortcomings of current therapies for non-small-cell lung cancer: Unmet medical needs. Oncogene, 28, S4–S13. 17. Pal, S. K., Childs, B. H., & Pegram, M. (2011). Triple negative breast cancer: Unmet medical needs. Breast Cancer Research and Treatment, 125(3), 627–636 .
• 18. Heslin, K. C., Cunningham, W. E., Marcus, M., Coulter, I., Freed, J., Der-Martirosian, C., Bozzette, S. A., Shapiro, M. F., Morton, S. C., & Andersen, R. M. (2001). A comparison of unmet needs for dental and medical care among persons with HIV infection receiving care in the United States. Journal of Public Health Dentistry, 61(1), 14–21.
• 19. Marcus, M., Freed, J. R., Coulter, I. D., Der-Martirosian, C., Cunningham, W., Andersen, R., Garcia, I., Schneider, D. A., Maas, W. R., Bozzette, S. A., & Shapiro, M. F. (2000). Perceived unmet need for oral treatment among a national population of HIV-positive medical patients: Social and clinical correlates. American Journal of Public Health, 90(7), 1059–1063.
• 20. Katz, M. H., Cunningham, W. E., Fleishman, J. A., Andersen, R. M., Kellogg, T., Bozzette, S. A., & Shapiro, M. F. (2001). Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Annals of Internal Medicine, 135(8), 557–565.
• 21. Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333.
• 22. Desai, M. M., & Rosenheck, R. A. (2005). Unmet need for medical care among homeless adults with serious mental illness. General Hospital Psychiatry, 27(6), 418–425.
• 23. Kertesz, S. G., McNeil, W., Cash, J. J., Desmond, R., McGwin, G., Kelly, J., & Baggett, T. P. (2014). Unmet need for medical care and safety net accessibility among Birmingham’s homeless. Journal of Urban Health, 91(1), 33–45.
• 24. Bhatt, A. (2015). Assessing unmet medical need in India: A regulatory riddle? Perspectives in Clinical Research, 6(1), 1.
• 25. Cavalieri, M. (2013). Geographical variation of unmet medical needs in Italy: A multivariate logistic regression analysis. International Journal of Health Geographics, 12, 27.
• 26. Kim J, Kim TH, Park EC, Cho WH. (2015). Factors influencing unmet need for health care services in Korea. Asia-Pacific Journal of Public Health, 27(2), NP2555–69.
• 27. Lucevic, A., Péntek, M., Kringos, D., Klazinga, N., Gulácsi, L., Brito Fernandes, Ó., Boncz, I., & Baji, P. (2019). Unmet medical needs in ambulatory care in Hungary: forgone visits and medications from a representative population survey. European Journal of Health Economics, 20, 71–78.
• 28. Madureira-Lima, J., Reeves, A., Clair, A., & Stuckler, D. (2018). The Great Recession and inequalities in access to health care: A study of unemployment and unmet medical need in Europe in the economic crisis. International Journal of Epidemiology, 47(1), 58–68.
• 29. Huang, J., Birkenmaier, J., & Kim, Y. (2014). Job loss and unmet health care needs in the economic recession: Different associations by family income. American Journal of Public Health, 104(11), e178–e183.
• 30. Jaworsky, D., Gadermann, A., Duhoux, A., Naismith, T. E., Norena, M., To, M. J., Hwang, S. W., & Palepu, A. (2016). Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada. Journal of Urban Health, 93(4), 666–681.
• 31. Argintaru, N., Chambers, C., Gogosis, E., Farrell, S., Palepu, A., Klodawsky, F., & Hwang, S. W. (2013). A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities. BMC Public Health, 13(1), 1-9.
• 32. Pappa, E., Kontodimopoulos, N., Papadopoulos, A., Tountas, Y., & Niakas, D. (2013). Investigating unmet health needs in primary health care services in a representative sample of the Greek population. International Journal of Environmental Research and Public Health, 10(5), 2017–2027.
• 33. Kolawole Jospeh, O. (2019). An Assessment of HIV Counselling and Testing (HCT) Service Utilization in Nigeria: A Binary Logistic Regression Approach. International Journal of HIV/AIDS Prevention. Education and Behavioural Science, 5(1), 26.
• 34. Zeng, G., & Zeng, E. (2019). On the relationship between multicollinearity and separation in logistic regression. Communications in Statistics: Simulation and Computation, 50(7), 1989-1997.
• 35. Prave, R. S., & Ord, J. K. (1993). Individual Logit Models for Consumer Preferences. Journal of Marketing Theory and Practice, 2(1), 27–39.
• 36. Busetta, A., Cetorelli, V., & Wilson, B. (2018). A Universal Health Care System? Unmet Need for Medical Care Among Regular and Irregular Immigrants in Italy. Journal of Immigrant and Minority Health, 20(2), 416–421.
• 37. Yoon, Y. S., Jung, B., Kim, D., & Ha, I.-H. (2019). Factors Underlying Unmet Medical Needs: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 16(13), 2391.
• 38. Lahelma, E., Martikainen, P., Laaksonen, M., & Aittomäki, A. (2004). Pathways between socioeconomic determinants of health. Journal of Epidemiology and Community Health, 58(4), 327–332.
• 39. Howe Hasanali, S. (2015). Immigrant-Native Disparities in Perceived and Actual Met/Unmet Need for Medical Care. Journal of Immigrant and Minority Health, 17(5), 1337–1346.
• 40. Han KT, Park EC, Kim SJ. (2016). Unmet healthcare needs and community health center utilization among the low-income population based on a nationwide community health survey. Health Policy (New York), 120(6), 630–7.
• 41. Israel S. (2016). How social policies can improve financial accessibility of healthcare: A multi-level analysis of unmet medical need in European countries. International Journal for Equity in Health, 15(1), 41. 42. Tucker-Seeley RD, Mitchell JA, Shires DA, Modlin CS. (2015). Financial Hardship, Unmet Medical Need, and Health Self-Efficacy Among African American Men. Health Education and Behavior, 42(3), 285–92.