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Updated: Aug 12, 2025

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Receiving or not deemed necessary healthcare services
Seher Nur Sulku1, Yagmur Tokatlioglu2, Kubra Cosar1
1Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500, Ankara, Türkiye, Turkey.
Background:
Avoiding deemed necessary healthcare needs may worsen prognosis and treatment options, and damage people's ability to perform their roles in society. Our study investigates why people avoid healthcare services in an upper-middle-income country, Türkiye.
Methods:
We apply TurkStat's 2012 Health Survey Data that includes a comprehensive health and social-demographic information of 28,055 survey participants who were 15 + aged. We use bivariate probit model to analyze the avoidance behavior in inpatient level in accordance with outpatient level because of the observed significant correlation between people's avoidance behavior under tertiary and lower level health care.
Results:
The findings show that 2.6% of 15 + aged population avoided deemed necessary hospital services. Furthermore, we found that high cost (31%), organizational factors (21%) and fear (12%) are prominent reasons of avoiding tertiary care. Thereafter, in our bivariate probit model findings, we figure out that being covered by social security schemes decreases the probability of avoiding both outpatient and inpatient health services by 6.9%. Moreover, being female, living in rural area, having lower income increase the chance of being avoider in both stages of healthcare.
Conclusion:
We conclude that social inequalities are the main underlying determinants of the avoiding behavior.
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