[Factors related to attitudes toward medical facility choice by the elderly why do the elderly favor large hospitals?].
OBJECTIVE
Factors associated with large hospital choice by the elderly were examined. Possible factors were divided among three domains; predisposing factors, need factors, and enabling or restraining factors. Both direct effects and interactive effects of those factors on choice attitudes were examined.


METHODS
The data were obtained from a face-to-face interview survey with a national sample aged 60 and over. The survey was conducted in 1996, and 2,447 elderly were interviewed. Choice attitudes were measured in two ways: 1) preference to use a large hospital regardless of disease, and 2) complaint of not being able to use a large hospital without an referral system by a clinic. Predisposing factors were age, sex and educational attainment. Need factors were assessed in terms of activities of daily living (ADL) and number of illnesses. Enabling or restraining factors included attitudes toward medical care, accessibility of medical facilities, home doctor existence at a clinic, and labor force participation.


RESULTS
18.5 percent of respondents reported a preference for large hospitals regardless of disease, and 51.3 percent had complaints about the referral system. Respondents with a higher number of illnesses were more likely to report a preference for use of a large hospital, regardless of the type of disease, and respondents with low ADL had more complaints about the referral system than those with higt ADL. The group who employed high technology as a criteria in choosing medical facilities, did not have a home doctor at a clinic, and had good access only to a large hospital, reported a strong preference for use of a large hospital regardless of disease type, and they also complained about the referral system. Regarding preference, an interactive effect between the number of illnesses and the existence of home doctor at a clinic was observed.


CONCLUSIONS
Existence of a home doctor in a clinic, attitudes toward medical care, and accessibility to medical facilities might have direct effects on choice of a large hospital, and only the existence of a home doctor at a clinic might have a strong influence decreasing this preference among the elderly with a higher number of illnesses.
Sugisawa
H
H
Department of Health Sociology, Tokyo Metropolitan Institute of Gerontology.
Sugihara
Y
Y
Kim
H K
HK
Shibata
H
H
D000368:Aged; D001294:Attitude to Health; D002755:Choice Behavior; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family