Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea
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초록
Objectives: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. Methods: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. Results: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. Conclusions: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
Abstract
Objectives: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. Methods: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. Results: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. Conclusions: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.
참고문헌 (40)
- Donabedian A, "Aspects of medical care administration: specifying requirements for health care", pp.65~68 (1973), Harvard University Press
- 허순임, "우리나라 성인의 미 충족의료 현황: 연령 간의 차이를 중심으로", 보건경제와 정책연구, 13(2), pp.1~16 (2007), 한국보건경제정책학회
- 신영전, "미 충족의료의 현황과 관련요인 -1차, 2차 한국복지패널자료를 이용하여-", 보건사회연구, 29(1), pp.95~122 (2009), 한국보건사회연구원[DOI]
- Alonso J, "Unmet health care needs and mortality among Spanish elderly", Am J Public Health, 87(3), pp.365~370 (1997)
- Lasalvia A, "Listening to patients’ needs to improve their subjective quality of life", Psychol Med, 35(11), pp.1655~1665 (2005)
- Kortrijk HE, "Changes in individual needs for care and quality of life in Assertive Community Treatment patients : an observational study", BMC Psychiatry, 14, pp.306~ (2014)
- 박형존, "건강관련 삶의 질에 대한 의료서비스 접근성의 영향과 소득수준의 조절효과", 보건과 사회과학, (31), pp.107~125 (2012), 한국보건사회학회[DOI]
- 박민정, "건강행위와 건강상태가 노인의 건강 관련 삶의 질에 미치는 영향: 2012년 한국의료패널 자료를 이용한 성별 분석", 지역사회간호학회지, 28(2), pp.118~128 (2017), 한국지역사회간호학회[DOI]
- Huh SI, "A study for unmet health care need and policy implication", Korea Inst Health Soc Aff, 5, pp.3~30 (2009)
- Heo J, "Poverty in the midst of plenty : unmet needs and distribution of health care resources in South Korea", PLoS One, 7(11), pp.e51004~ (2012)
- 주성식, "일개 섬 지역 주민의 미충족 의료와 관련 요인", 농촌의학.지역보건, 35(2), pp.151~164 (2010), 한국농촌의학.지역보건학회
- Park S, "Poverty and working status in changes of unmet health care need in old age", Health Policy, 120(6), pp.638~645 (2016)
- Marmot M, "The influence of income on health: views of an epidemiologist", Health Aff (Millwood), 21(2), pp.31~46 (2002)
- Lindahl M, "Estimating the effect of income on health and mortality using lottery prizes as an exogenous source of variation in income", J Hum Resour, XL(1), pp.144~168 (2005)
- Frijters P, "The causal effect of income on health : evidence from German reunification", J Health Econ, 24(5), pp.997~1017 (2005)
- Aaberge R, "The sensitivity of income inequality to choice of equivalence scales", Rev Income Wealth, 44(4), pp.565~569 (1998)
- Idler EL, "Self-rated health and mortality : a review of twenty-seven community studies", J Health Soc Behav, 38(1), pp.21~37 (1997)
- Idler EL, "Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study", Am J Public Health, 80(4), pp.446~452 (1990)
- 우혜경, "주관적 건강상태에 따른 사망률 차이", 보건행정학회지, 18(4), pp.49~65 (2008), 한국보건행정학회
- Ko H, "Unmet healthcare needs and health status : panel evidence from Korea", Health Policy, 120(6), pp.646~653 (2016)
- Richiardi L, "Mediation analysis in epidemiology : methods, interpretation and bias", Int J Epidemiol, 42(5), pp.1511~1519 (2013)
- Preacher KJ, "Advances in mediation analysis : a survey and synthesis of new developments", Annu Rev Psychol, 66, pp.825~852 (2015)
- Imai K, "A general approach to causal mediation analysis", Psychol Methods, 15(4), pp.309~334 (2010)
- Imai K, "Unpacking the black box of causality : learning about causal mechanisms from experimental and observational studies", Am Polit Sci Rev, 105(4), pp.765~789 (2011)
- Bynum B, "The McKeown thesis", Lancet, 371(9613), pp.644~645 (2008)
- Reeves A, "Public pensions and unmet medical need among older people : cross-national analysis of 16 European countries, 2004-2010", J Epidemiol Community Health, 71(2), pp.174~180 (2017)
- Karanikolos M, "Access to care in the Baltic States : did crisis have an impact", Eur J Public Health, 26(2), pp.236~241 (2016)
- Blakely TA, "What is the lag time between income inequality and health status", J Epidemiol Community Health, 54(4), pp.318~319 (2000)
- 강영주, "한국사회의 소득불평등과 건강에 관한 실증연구: 한국노동패널 자료를 중심으로", 한국행정학보, 46(4), pp.265~291 (2012), 한국행정학회
- "Interrelated dynamics of health and poverty in Australia" (2009)[URL]
- Idler EL, "Self-ratings of health : do they also predict change in functional ability", J Gerontol B Psychol Sci Soc Sci, 50(6), pp.S344~S353 (1995)
- 송경신, "미충족 의료에 미치는 관련 요인 분석", 대한보건연구, 37(1), pp.131~140 (2011), 사단법인 대한보건협회[DOI]
- 신자은, "건강보험 가입 재가 장애인의 미충족 의료 경험에 영향을 미치는 요인", 보건사회연구, 33(2), pp.549~577 (2013), 한국보건사회연구원[DOI]
- 손창우, "홍콩 이주 한인의 미충족 의료에 영향을 미치는 요인", 대한보건연구, 41(1), pp.107~121 (2015), 사단법인 대한보건협회[DOI]
- 허순임, "미충족 의료 경험과 보건의료체계에 대한 인식", 보건경제와 정책연구, 22(1), pp.59~89 (2016), 한국보건경제정책학회
- 이혜재, "노인의 미충족 의료 경험의 결정요인 – 가구 유형을 중심으로", 보건경제와 정책연구, 23(2), pp.85~108 (2017), 한국보건경제정책학회
- Levesque JF, "Patient-centred access to health care : conceptualising access at the interface of health systems and populations", Int J Equity Health, 12, pp.18~ (2013)
- Socioeconomic inequalities in health in Korea: magnitude of its challenges and strategy for alleviation (I), "Kim DJ", Korea Institute for Health and Social Affairs, 357~358 (2016)
- Turnes PB, "The Use of longitudinal mediation models for testing causal effects and measuring direct and indirect effects", China USA Bus Rev, 15(1), pp.1~13 (2016)
- VanderWeele TJ, "Mediation analysis with time varying exposures and mediators", J R Stat Soc B, 79(3), pp.917~938 (2017)
