Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
The Predictors of Healthcare Utilization and Analyzing Equity Level in Healthcare Utilization in Türkiye: Cross-Sectional Research
Sağlık Hizmetleri Kullanımında Hakkaniyet: Türkiye Sağlık Sisteminin Değerlendirilmesi: Kesitsel Araştırma
Abide AKSUNGURa, Yusuf ÇELİKb
aAnkara Altındağ District Health Directorate, Ankara, Türkiye
bDepartment of Health Administration, Marmara University Faculty of Health Sciences, İstanbul, Türkiye
Turkiye Klinikleri J Health Sci. 2022;7(3):837-46
doi: 10.5336/healthsci.2021-86408
Article Language: EN
Full Text
ABSTRACT
 Objective: This study aims to analyse and evaluate the equity level of healthcare utilization by years in Türkiye by exploring the relationship between health services utilization and the factors that are predisposing, enabling and need factors in 'Behavioural Model' developed by Andersen. Material and Methods: The concentration index and regression analyses were used to estimate equity levels and to explore the effects of predisposing, enabling and need factors. Data of 5 Türkiye Health Surveys conducted in years of 2008, 2010, 2012, 2014 and 2016 was used to reach this study's purposes. Equity in healthcare utilization was investigated for four healthcare utilization indicators: 1) Services provided by family/practitioner physicians, 2) Services provided by specialized physicians, 3) Day care/outpatient care services, and 4) Inpatient care services provided by hospitals. Results: Estimated concentration index values for income level, education level, and number of diseases showed that health services utilization was concentrated among people having less income and education level as well as more diseases. Regression analyses also indicated that the variables of income and education level, and disease existence and number of diseases as well as some other socio-demographic characteristics of individuals had significant effects on health services utilization. Conclusion: Considering the effects of predisposing, enabling and need factors on the utilization of health services in Türkiye by years, it might be concluded that equity level in Turkish Healthcare System has been improved.

Keywords: Health equity; patient acceptance of health care; health services accessibility
ÖZET
 Amaç: Bu çalışmanın amacı, Andersen tarafından geliştirilen davranışsal model çerçevesinde eğilim faktörleri, kolaylaştırıcı faktörler ve ihtiyaç faktörleri ile sağlık hizmeti kullanımı arasındaki ilişkiyi incelemek ve Türkiye'de yıllar içerisinde sağlık hizmeti kullanımında hakkaniyet seviyesinde iyileşme olup olmadığını analiz etmek ve değerlendirmektir. Gereç ve Yöntemler: Eğilim faktörleri, kolaylaştırıcı faktörler ve ihtiyaç faktörlerinin etkisini incelemek hakkaniyet seviyesini tahmin etmek için konsantrasyon indeksi ve regresyon analizi kullanılmıştır. Bu çalışmanın amaçlarına ulaşmak için 2008, 2010, 2012, 2014 ve 2016 yıllarında gerçekleştirilen Türkiye Sağlık Araştırması'nın 5 yıllık verileri kullanılmıştır. Sağlık hizmeti kullanımında hakkaniyet 4 sağlık hizmeti kullanım göstergesi için araştırılmıştır: 1) Aile/pratisyen hekimler tarafından sağlanan hizmetler, 2) Uzman hekimler tarafından sağlanan hizmetler, 3) Gündüz/ayakta bakım hizmetleri ve 4) Hastaneler tarafından sunulan yataklı tedavi hizmetleri. Bulgular: Gelir, eğitim düzeyi ve hastalık sayısı için konsantrasyon indeksi değerleri, daha düşük gelir ve eğitim düzeyine sahip kişiler ile daha fazla hastalığa sahip kişiler arasında sağlık hizmeti kullanımının yoğunlaştığını göstermiştir. Ayrıca regresyon analizleri bireylerin diğer bazı sosyodemografik özelliklerinin yanı sıra gelir ve eğitim düzeyi, hastalık varlığı ve hastalık sayısı değişkenlerinin de sağlık hizmeti kullanımı üzerinde önemli etkileri olduğunu göstermiştir. Sonuç: Sağlık hizmetleri kullanımına eğilim faktörleri, kolaylaştırıcı faktörler ve ihtiyaç faktörleri açısından bakıldığı zaman Türkiye Sağlık Sistemi'nde hakkaniyetin sağlandığı ve yıllar içerisinde sağlık hizmetine erişimde hakkaniyet seviyesinde iyileşme olduğu söylenebilir.

Anahtar Kelimeler: Sağlıkta hakkaniyet; sağlık hizmetinin hasta tarafından kabulü; sağlık hizmetlerine erişim
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