National Health Surveys and the Behavioral Model of Health Services Use

Andersen, Ronald

doi:10.1097/mlr.0b013e31817a835d

Cited by 841 publications

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“…En su formulación revisada el «modelo conductual» propone la existencia de unos determinantes primarios (características ambientales, y de los individuos) que producen una conducta en salud (hábitos en salud y uso del sistema sanitario), que a su vez producen unos resultados en salud (percepción del estado de salud, un estado de salud evaluable y una satisfacción en el usuario) 2 . Los determinantes primarios, tanto ambientales como individuales se pueden agrupar en factores predisponentes, facilitadores y de «necesidad» 3 .…”

Section: Introductionunclassified

“…El estudio de los sistemas de salud con este modelo ha permitido detectar inequidades en el acceso a la atención sanitaria 3,18 , que el propio Andersen definía como una excesiva variabilidad en el uso de servicios ligada a las diferencias en factores ambientales como la estructura social o las creencias en salud, o en factores facilitadores individuales como la renta.…”

Section: Introductionunclassified

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La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual

Fernández

Gómez-Gascón

Cura-González

et al. 2010

Rev. Esp. Salud Publica

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RESUMENFundamento: La utilización de servicios sanitarios se ha estudiado desde varios modelos conceptuales. El objetivo de este trabajo es valorar la influencia de la calidad de vida relacionada con la salud (CVRS) en la variabilidad de la utilización de la consulta de atención primaria bajo el «modelo conductual».Métodos: Estudio transversal analítico. Se entrevistó a 451 sujetos de 6 centros de salud en la Comunidad de Madrid. Se recogieron característi-cas relacionadas con factores ambientales e individuales (predisponentes, facilitadores y de necesidad) y la CVRS (Euroqol-5D). La utilización se recogió de la historia clínica informatizada.Resultados: Hubo una mediana de 13 visitas/año (rango intercuartil 7-20). La CVRS explicaba un 5,2% de la variabilidad en la utilización, vivir en barrios de rentas altas un 2,4%, la edad un 7,4%, la renta individual un 1,0% y los factores relacionados con «necesidad» (enfermedades cró-nicas e ingresos hospitalarios) explicaban un 4,1% de variabilidad adicional. Cada cambio de tercil de la CVRS se asoció con una disminución del 13,8% en las consultas/año. La residencia en zonas de renta alta y cada aumento de 1000 de renta individual disminuían la utilización un 17,5% y un 9,5% respectivamente. La edad se asociaba con un aumento de un 8,0% de visitas/año por década. El sufrir enfermedades crónicas o ingresos hospitalarios suponía aumentar un 51,9% y un 26,5% las visitas anuales.Conclusiones: La CVRS se asocia de manera independiente con la variabilidad en la utilización de la consulta del médico de familia, una vez ajustado el efecto de la necesidad, como propone el «modelo conductual». ABSTRACT Quality of Life Related to Health as a Factor Explaining the Use of Family Medical Consultation: A Study on the Behavioral ModelBackground: Health services utilization has been studied under several conceptual models. This study is aimed to assess the influence of Health Related Quality of Life (HRQL) on the variability of the primary care consultation utilization under the «behavioral model» Methods: A cross-sectional study. Interviews were conducted with 451 subjects at six health centers in the Community of Madrid. Environmental and individual characteristics (predisposing, enabling and need factors) and HRQL (EuroQol-5D) were collected. Annual visits were retrieved from the computerized clinical history.Results: Median utilization was 13 visits/year (interquartile range 7-20). HRQL explained 5,2% of utilization variability, living in high-income areas an additional 2.4%, age a 7.4%, incomes a 1.0% and «need factors» (chronic illnesses or a hospital admission in the last year) explained an additional 4.1% of the variability. Each increase of the tercile in the perception of HRQL was associated with a decrease of 13,8% of the number of visits/year. Living in high-income areas, and each increase of 1000 in the incomes decreased the percentage of annual visits 17.5 % and 9.5% respectively. Age is associated with an increase of 8.0% of annual visits per decade. Suffering from chron...

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Section: Introductionunclassified

La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual

Fernández

Gómez-Gascón

Cura-González

et al. 2010

Rev. Esp. Salud Publica

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“…If access to services occurs in an equitable manner, the factor of need should be the main determinant in the use, whereas predisposing and enabling factors should represent a small proportion of the variation in use of services. Access to health services can be considered fair if the need factor is the primary determinant of use 26 . A limitation of this study was the difficulty in validating the outcome due to the potential for recall bias, which may lead to an underestimation or overestimation of the outcome and explanatory variables, such as the prevalence of chronic diseases.…”

Section: Discussionmentioning

confidence: 99%

“…In the final model, variables with p < 0.05 were maintained. In this model, the predisposing, enabling and need factors were used as proposed by Andersen 26 .…”

Section: Methodsmentioning

confidence: 99%

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Factors associated to medical consultations by elderly adults in southern Brazil: a population based study

Destro

Boing

d’Orsi

2014

Rev. bras. epidemiol.

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ABSTRACT:Objective: To analyze the prevalence of medical consultations in the last three months among elderly adults and associated factors. Methods: A cross-sectional, population-based study was carried out with 1,705 elderly adults (60+ years of age) in the urban region of Florianópolis, Santa Catarina, Brazil, in 2009 and 2010. The sampling selection was performed in two stages. The sample was complex, with census tracts as primary and households as secondary sampling units. For association analysis, Poisson regression was performed using predisposing factors, enabling factors and need as independent variables, according to Andersen's theoretical model. Results: The response rate was 89.2%. The prevalence of medical appointments by elderly adults was 70.4% (95%CI = 67.5 -73.4). Factors associated with higher prevalence of medical consultations in the crude analysis were female gender, accumulation of chronic diseases, negative self-perception of health, and report of chronic pain. The multivariate analysis showed that having at least one chronic disease and negative self-perception of health was positively associated with the outcome. Conclusion: Only variables from the need dimension were associated with medical consultations, indicating an equal use of this service.

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Association of Maternal Citizenship and State-Level Immigrant Policies With Health Insurance Coverage Among US-Born Latino Youths

et al. 2020

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IMPORTANCE The association of state-level immigrant policies with uninsurance among Latino youths remains unknown. OBJECTIVE To assess the association of state-level immigrant integration and criminalization policies with health insurance coverage among US-born Latino youths by maternal citizenship. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed secondary data from the American Community Survey, January 1, 2016, to December 31, 2018, for US-born Latino youths (age, Յ17 years) and their mothers (age, 18-64 years) as well as state-level indicators of immigrant integration and criminalization policies (in all 50 states and the District of Columbia). EXPOSURES Immigrant integration and criminalization policies. MAIN OUTCOMES AND MEASURES The main outcome was maternal reports of youth uninsurance status at the time of the American Community Survey interview. Variation in youth uninsurance by maternal citizenship, state immigrant integration policy context, and state immigrant criminalization policy context were examined. All analyses were conducted with weighted survey data. RESULTS Of the 226 691 US-born Latino youths (115 431 [50.92%] male; mean [SD] age, 7.66 [4.92] years) included in the study, 36.64% (95% CI, 36.21%-36.92%) had noncitizen mothers. Overall, 7.09% (95% CI, 6.78%-7.41%) of noncitizen mothers reported that their youths were uninsured compared with 4.68% (95% CI, 4.49%-4.88%) of citizen mothers. Of uninsured youths who resided in states with a low level of immigrant integration policies, 9.10% (8.22%-10.06%) had noncitizen mothers and 4.75% (95% CI, 4.19%-5.37%) had citizen mothers; of uninsured youths who resided in states with high criminalization policies, 9.37% (95% CI, 8.90%-9.87%) had noncitizen mothers and 5.91% (95% CI, 5.64%-6.20%) had citizen mothers. In states with few immigrant integration policies, the probability of uninsurance among youths with noncitizen mothers was 3.3% (95% CI, 2.3%-4.4%) higher than that among youths with citizen mothers. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those residing in states with a low level vs a high level of immigrant integration policies was 2.1% (95% CI, 0.6%-3.6%). Among youths residing in states with high levels of immigrant criminalization policies, those with noncitizen mothers had a 2.6% (95% CI, 1.9%-3.0%) higher probability of being uninsured compared with those whose mothers were citizens. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those who resided in a state with a low level vs a state with a high level of immigrant criminalization policies was 1.7% (95% CI, 0.7%-2.7%).

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National Health Surveys and the Behavioral Model of Health Services Use

Cited by 841 publications

References 11 publications

La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual

La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual

Factors associated to medical consultations by elderly adults in southern Brazil: a population based study

Association of Maternal Citizenship and State-Level Immigrant Policies With Health Insurance Coverage Among US-Born Latino Youths

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