Unmet healthcare needs of elderly people in Korea

Poverty and suicide risk in older adults: A retrospective longitudinal cohort study

OBJECTIVES

We aimed to identify the impact of poverty on suicide risk in older adults.

METHOD

The data used in this study was obtained from the National Health Insurance Service-Senior claims database from 2002 to 2013. A total of 558 147 individuals were followed for up to 12 years. Poverty was assessed from insurance premium levels, and causes of death were analysed by linking individuals' deaths to the data for causes of death from the National Statistics Office in South Korea. Cox proportional hazard models were used to analyse the associations between poverty and suicide deaths after adjustments for possible confounders.

RESULTS

Among 558 147 older adults (aged 60-119 years), the poverty group had an increased risk of suicide compared with the high-income group (adjusted hazard ratio [AHR], 1.34; 95% confidence interval [CI], 1.22-1.47), and poverty-group males had a significantly higher risk of suicide than males in the high-income group (AHR, 1.50; 95% CI, 1.33-1.68). Adults aged 60 to 74 years in the poverty group had a higher risk of suicide than those with a high income in the same age group (AHR, 1.41; 95% CI, 1.27-1.57). However, no statistically significant income gradient was found for females or adults aged 75 years or older.

CONCLUSIONS

Our findings revealed that poverty is a risk factor for death by suicide in older adults. Suicide prevention strategies for older adults should be specifically tailored by income level.

Factors Underlying Unmet Medical Needs: A Cross-Sectional Study

Unmet medical needs refer to the state where a patient's medical care or service is insufficient, inadequate, or lacking. Numerous factors influence unmet medical needs. We used a multi-pronged approach to explore the factors influencing unmet medical needs in the Korean health care system according to Anderson's Behavioral Model of Health Services Use. To this end, we used data from 11,378 adults over 19 years old in the 2016 Korea Health Panel Survey and performed multiple logistic regression analyses. The odds of experiencing unmet medical needs were significantly greater among older participants (odds ratio (OR) = 2.51, 95% confidence interval (CI) = 1.78-3.56); low-income participants (OR = 1.41, 95% CI = 1.14-1.75); non-workers (OR = 1.24, 95% CI = 1.06-1.46); those who had received non-covered treatment (OR = 1.24, 95% CI = 1.08-1.42); those who did not regularly exercise (OR = 1.23, 95% CI = 1.02-1.48); and those experiencing pain (OR = 2.29, 95% CI = 1.97-2.66), worse self-rated health status (OR = 2.29, 95% CI = 1.89-2.79), and severe depression (OR = 2.46, 95% CI = 1.39-4.35). About one in ten Korean citizens (11.60%) have unmet medical service needs. Policies that strengthen coverage for physically and economically vulnerable groups are needed.

Why not see a doctor when ill? Evidence from the Chinese elderly

BACKGROUND

Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as "not see a doctor". This study aimed to describe the reason distribution of"not see a doctor" among the Chinese elderly. Specifically,we examined the reasons why"not see a doctor" happened to the Chinese elderly with different characteristics.

METHODS

In order to explore the associations between various predisposing, enabling and need factors and "not see a doctor" in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between "not see a doctor" and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for "not see a doctor").

RESULTS

Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported "not see a doctor". Overall, those with older age, other marital status (except married) and poorer health status were more likely to report "not see a doctor". No significant associations were found between income and "not see a doctor". The majority of cases report "no need" as the reason for their "not see a doctor". Except reason "no need", factor associated with the healthcare system-cost-accounted for the most case of "not see a doctor". Those without health insurance are more likely not to see a doctor due to affordability issues.

CONCLUSIONS

This quantitative study suggests that "not see a doctor" is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.