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Context and healthcare access: looking beyond the individual
David Litaker1, Siran M Koroukian, Thomas E Love
1Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio 44106, USA. David.Litaker@med.va.gov
Medical Care
|May 24, 2005
Summary
Contextual factors like poverty and urbanization significantly impact healthcare access, even when individual characteristics are considered. Addressing these community-level issues is crucial for equitable healthcare. (32 words)
Area of Science:
- Health Services Research
- Social Determinants of Health
- Health Equity
Background:
- Individual characteristics and choices influence health outcomes.
- Contextual attributes also play a significant role in health.
- The impact of contextual factors on healthcare system entry is less understood.
Purpose of the Study:
- To assess the association between contextual characteristics and having a usual source of healthcare.
- To identify community-level factors influencing healthcare access.
Main Methods:
- Utilized cross-sectional, survey-weighted data from 16,261 adult Ohio residents (1998).
- Linked individual data with county-level data from Area Resource File and 1990 US Census.
- Employed multilevel logistic regression models analyzing social, economic, and health system characteristics.
Main Results:
- 18.0% of individuals reported no usual source of care.
- Individual factors (health, insurance, income, education, social support) were associated with care access.
- County-level factors, specifically poverty and urbanization, showed significant independent associations.
Conclusions:
- Health disparities persist, highlighting the need for equitable healthcare access programs.
- Policy interventions should consider community-level economic factors for improved healthcare access.
- Addressing upstream, contextual determinants is vital for health equity.