title: Access disparity and health inequality of the elderly: unmet needs and delayed healthcare.
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.
authors: 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. tyamada@crab.rutgers.edu.
authors: Tetsuji
authors: T
authors: Yamada
authors: Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, 95 Grasslands Rd., Valhalla, NY 10595, USA. ChiaChing_Chen@nymc.edu.
authors: Chia-Ching
authors: CC
authors: Chen
authors: 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. cmurata@ncgg.go.jp.
authors: Chiyoe
authors: C
authors: Murata
authors: Department of Civil Environmental Engineering, Iwate University, 4-3-5, Ueda, Morioka-shi, Iwate-ken, 020-8551 Japan. hirai181kan@gmail.com.
authors: Hiroshi
authors: H
authors: Hirai
authors: Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu-shi, Shizuoka-ken, 431-3192 Japan. ojima@hama-med.ac.jp.
authors: Toshiyuki
authors: T
authors: Ojima
authors: Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba-ken, 260-8670 Japan. kkondo@chiba-u.jp.
authors: Katsunori
authors: K
authors: Kondo
authors: Department of Public Policy and Administration, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA. hajoseph@scarletmail.rutgers.edu.
authors: Joseph R
authors: JR
authors: Harris
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D020380:Needs Assessment; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D014481:United States
references: Health Place. 2008 Sep;14(3):406-14
references: 17913562
references: J Health Econ. 2009 Jan;28(1):169-75
references: 18996608
references: Bull World Health Organ. 2000;78(1):55-65
references: 10686733
references: J Ambul Care Manage. 2009 Oct-Dec;32(4):342-50
references: 19888011
references: Track Rep. 2008 Sep;(21):1-5
references: 18814387
references: Am J Public Health. 2012 Aug;102(8):1535-41
references: 22698020
references: JAMA. 2003 Mar 12;289(10):1297-302
references: 12633192
references: Gerontologist. 1994 Aug;34(4):470-5
references: 7959103
references: Am J Public Health. 2006 Jul;96(7):1300-7
references: 16735628
references: J Community Health. 2002 Feb;27(1):33-51
references: 11845940
references: Health Econ Policy Law. 2012 Jul;7(3):263-83
references: 20854723
references: Health Policy. 2006 Mar;76(1):72-9
references: 15993978
references: Health Serv Res. 2004 Oct;39(5):1527-46
references: 15333121
references: Issue Brief Cent Stud Health Syst Change. 2003 Mar;(61):1-4
references: 12647763
references: Med Care. 2007 Jan;45(1):88-94
references: 17279025
references: J Health Econ. 2003 Jan;22(1):61-87
references: 12564718
references: Am J Manag Care. 2000 Nov;6(11):1189-96
references: 11185844
references: Adv Health Econ Health Serv Res. 2005;16:431-50
references: 17867251
references: Health Econ. 1997 May-Jun;6(3):303-19
references: 9226147
references: J Health Soc Behav. 1995 Mar;36(1):1-10
references: 7738325
references: N Engl J Med. 2002 Apr 25;346(17):1288-93
references: 11973366
references: Health Serv Res. 2007 Aug;42(4):1520-43
references: 17610436
references: Track Rep. 2004 Aug;(10):1-4
references: 15338575
references: Med Care. 2006 May;44(5 Suppl):I64-72
references: 16625066
references: J Health Commun. 2006;11 Suppl 1:157-72
references: 16641081
references: Health Serv Res. 2005 Dec;40(6 Pt 1):1898-917
references: 16336555
references: Med Care. 2005 Apr;43(4):356-73
references: 15778639
references: Med Care. 2007 Sep;45(9):842-50
references: 17712254
references: J Med Internet Res. 2003 Jul-Sep;5(3):e17
references: 14517108
references: Am J Public Health. 2004 Jan;94(1):53-9
references: 14713698
references: Issue Brief Cent Stud Health Syst Change. 2007 Oct;(114):1-6
references: 17922543
references: Health Serv Res. 2000 Apr;35(1 Pt 2):219-37
references: 10778811
references: Health Policy. 2009 Jan;89(1):37-45
references: 18550203
references: JAMA. 2005 Jul 20;294(3):359-65
references: 16030281
references: J Health Econ. 1993 Dec;12(4):431-57
references: 10131755
references: Issue Brief (Commonw Fund). 2009 Jul;63:1-14
references: 19626725
references: J Urban Health. 2003 Dec;80(4):650-7
references: 14709712