RESUMO
In this study, we test the assumption that sociocultural differences in use of health services will only occur below a certain level of illness severity. Data are derived from the Curaçao Health Study (n = 2248). Subjects' educational level and degree of proto-professionalization are used as indicators of their sociocultural background. Differences in the likelihood of seeking professional care for several common health problems are analyzed, and are compared with the help-seeking behavior for chronic disorders. As hypothesized, higher educated and proto-professionalized people are less likely to seek care for everyday symptoms. In addition, proto-professionalization is accompanied by a greater likelihood of using over the counter medication. Increasing empowerment of patients appears to lead to increased self care for everyday symptoms. When conditions reach a more serious stage, the differences in help-seeking behavior disappear: for most of the chronic conditions studied, the higher educated and more proto-professionalized individuals are just as likely to seek professional treatment as the less advantaged groups. However, there is a difference as to the type of professional consulted for chronic health problems. Proto-professionalized individuals more often receive specialist treatment, probably because they are better equipped to persuade GPs to refer. The adverse side of patient empowerment may be increasing consumerism: a situation in which patient demands, not medical necessity, determine the care delivered.
Assuntos
Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Doença Aguda , Doença Crônica , Características Culturais , Humanos , Entrevistas como Assunto , Funções Verossimilhança , Antilhas Holandesas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Poder Psicológico , Autocuidado , Classe Social , Fatores SocioeconômicosRESUMO
The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Indigência Médica/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antilhas Holandesas , Revisão da Utilização de Recursos de SaúdeRESUMO
This study examines whether there is socioeconomic equity in health care utilization in Curacao. We explore how education level is related to utilization of various health services, taking into account the effects of sex, age, and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis; probability (or incidence) of services use versus overall volume contacts. The data was derived from the "Curacao health study", a health interview survey among a random sample (n=2248) of the non-institutionalized population 18 years and over. The results indiacte that there is socio-economic inequalities in health (need for care) is taken into account. In other words: greater need for services are not met by greater use (vertical equity) and similar needs for care are not met by similar levels of service use (horizontal inequity). The volume of use (i.e. the number of consultations with a care provider, once a person has entered the health care system) appears to be fairly equitable. The observed inequalities in probability of specialist and health utilization contrast with findings from international research. The outcomes of this study underline the importance of health care reforms in order to attain more equitatble access to health care. (AU)