Urban and Rural Disparities in Hospital Utilization among Indonesian Adults
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Abstract
Background: Equal access to healthcare facilities, patient’s satisfaction, and respect for the desire of the patient were recognized as the basic principles of each of the health care system. Each person must be given the opportunity to access health services in accordance with the requirements of their health. We aimed to prove the existence of disparities hospital utilization based on the category of urban-rural areas.
Methods: The research used the 2013 Indonesian Basic Health Survey (RKD) as analysis material, that was designed a cross-sectional survey. With the multi-stage cluster random sampling method, 722,329 respondents were obtained. Data were analyzed using Multinomial Logistic Regression tests.
Results: The results showed adults living in urban were likely to use hospital outpatient facilities 1.246 times higher than adults living in rural areas (OR 1.246; 95% CI 1.026 – 1.030). The likelihood of utilizing at the same time outpatient and inpatient facilities at 1.134 times higher in adults living in urban than those in rural areas (OR 1.134; 95% CI 1.025 - 1.255). While for the category of hospital inpatient utilization, there was no significant difference.
Conclusion: There was a disparity in hospital utilization between urban-rural areas. Urban show better utilization than rural areas in outpatient and at the same time the use of inpatient care.
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23. Liu X, Wong H, Liu K (2016). Outcome-based health equity across different social health insurance schemes for the elderly in China. BMC Health Serv Res., 16: 9.
24. Wehby GL, Pawluk M, Nyarko KA, López-Camelo JS (2018). Explaining ethnic disparities in preterm birth in Argentina and Ecuador. Glob Public Health, 13(8):1126–43.
25. Saadi A, Himmelstein DU, Woolhandler S, Mejia NI (2017). Racial disparities in neurologic health care access and utilization in the United States. Neurology, 88(24):2268–75.
26. Whitfield GP, Carlson SA, Ussery EN et al (2018). Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey – 2015. Prev Med (Baltim), 114:57–63.
27. Park YJ, Martin EG (2018). Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care. Health Serv Res., 53:2932–51.
28. Gao F, Kihal W, Meur N, Souris M, Deguen S (2017). Does the edge effect impact on the measure of spatial accessibility to healthcare providers? Int J Health Geogr., 16(1):46.
29. Brian D. Smedley, Stith AY, Nelson AR (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Available from: http://www.precaution.org/lib/iom_on_health_disparities.020601.pdf
30. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W (2012). Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan, 27(4):288-300.
31. Wang S, Kou C, Liu Y et al (2014). Rural–Urban Differences in the Prevalence of Chronic Disease in Northeast China. Asia-Pacific J Public Heal, 27(4):394-406.
32. Cheng L, Tan L, Zhang L et al (2013). Chronic disease mortality in rural and urban residents in Hubei Province, China, 2008-2010. BMC Public Health, 13:713.
33. Emamgholipour Sefiddashti S, Kazemi Karyani A, Ghazanfari S (2016). The disparity in geographical accessibility to healthcare resources in Iran: the comparison of two cross-section. Int J Hum Rights Healthc, 9(2):86–94.
34. Tourani S, Zarezadeh M, Raadabadi M, Pourshariati F (2017). Association of regional disparity of obstetrics and gynecologic services with children and infants mortality rates: A cross-sectional study. Int J Reprod Biomed (Yazd), 15(3):147–54.
35. Anjomshoa M, Mousavi SM (2014). Regional disparities in the distribution of health care facilities: Building evidence for evidence-based policy making. Iran J Public Health, 43(7):1020–1.
36. Rostami M, Karamouzian M, Khosravi A, Rezaeian S (2018). Gender and geographical inequalities in fatal drug overdose in Iran: A province-level study in 2006 and 2011. Spat Spatiotemporal Epidemiol, 25:19–24.
37. Mansori K, Solaymani-Dodaran M, Mosavi-Jarrahi A et al (2018). Spatial inequalities in the incidence of colorectal cancer and associated factors in the neighborhoods of Tehran, Iran: Bayesian spatial models. J Prev Med Public Health, 51(1):33–40.
38. Momenyan S, Kavousi A, Poorolajal J, Momenyan N (2018). Spatial inequalities and predictors of HIV/AIDS mortality risk in Hamadan, Iran: a retrospective cohort study. Epidemiol Health, 40: e2018038.
2. Tzeng H-M, Okpalauwaekwe U, Yin C-Y, Jansen SL, Feng C, Barker A (2018). Do patients’ demographic characteristics affect their perceptions of self-care actions to find safe and decent care? Appl Nurs Res, 43:24–9.
3. Li J, Shi L, Liang H, Ding G, Xu L (2018). Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011. BMC Health Serv Res, 18(102):1–9.
4. United Nations Group of Experts on Geographical Names (2017). United Nations Conference on the Standardization of Geographical Names , 11th. 2017. Available from: https://unstats.un.org/unsd/geoinfo/UNGEGN/ungegnConf11.html
5. Central Bureau of Statistics of Indonesia (2011). Citizenship, Ethnicity, Religion, and Everyday Language Indonesian Residents. Results of the 2010 Population Census. Central Bureau of Statistics of Indonesia, Jakarta.
6. NIHRD of Indonesia (2013). The 2013 Indonesia Basic Health Survey (RKD): National Report. NIHRD, Jakarta.
7. Kelishadi R, Qorbani M, Motlagh ME, Ardalan G, Heshmat R, Hovsepian S (2016). Socioeconomic disparities in dietary and physical activity habits of Iranian children and adolescents: The CASPIAN-IV study. Arch Iran Med, 19(8):530–7.
8. Commission on Social Determinants of Health WHO (2008). Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. WHO, Geneva.
9. Li C, Yao NA, Yin A (2018). Disparities in dental healthcare utilization in China. Community Dent Oral Epidemiol, 46(6):576-585.
10. Loree JM, Javaheri KR, Lefresne SV et al (2017). Impact of Travel Distance and Urban-Rural Status on the Multidisciplinary Management of Rectal Cancer. J Rural J Rural Health, 33(4): 393-401.
11. Holliday TL, Suggs PD, Thompson SN, Richmond BK (2017). Disparities in rural breast cancer care: Factors affecting choice of breast reconstruction in a West Virginia Tertiary Care Hospital. Am Surg., 83(7) 717-721.
12. Gonzales S, Mullen MT, Skolarus L, Thibault DP, Udoeyo U, Willis AW (2017). Progressive rural-urban disparity in acute stroke care. Neurology, 88(5):441–8.
13. Bobo FT, Yesuf EA, Woldie M (2017). Inequities in utilization of reproductive and maternal health services in Ethiopia. Int J Equity Health, 16: 105.
14. Kenea D, Jisha H (2017). Urban-rural disparity and determinants of delivery care utilization in Oromia region, Ethiopia: Community-based cross-sectional study. Int J Nurs Pract.,23(1) doi: 10.1111/ijn.12510.
15. Dorjdagva J, Batbaatar E, Svensson M, Dorjsuren B, Batmunkh B, Kauhanen J (2017). Free and universal, but unequal utilization of primary health care in the rural and urban areas of Mongolia. Int J Equity Health, 16: 73.
16. Wen P-C, Lee CB, Chang Y-H, Ku L-JE, Li C-Y (2017). Demographic and rural-urban variations in dental service utilization in Taiwan. Rural Remote Health, 17(3):4161.
17. Chiang CL, Chen PC, Huang LY et al (2016). Impact of universal health coverage on urban-rural inequity in psychiatric service utilisation for patients with first admission for psychosis: A 10-year nationwide population-based study in Taiwan. BMJ Open, 6(3): e010802.
18. Do N, Tran HTG, Phonvisay A, Oh J (2018). Trends of socioeconomic inequality in using maternal health care services in Lao People’s Democratic Republic from year 2000 to 2012. BMC Public Health, 18(1): 875.
19. Meng Q, Xu L, Zhang Yet al (2012). Trends in access to health services and financial protection in China between 2003 and 2011: A cross-sectional study. Lancet, 379:805–14.
20. Xu Y, Ma J, Wu N et al (2018). Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China. PLoS One, 13(3): e0194539.
21. Qian Y, Zhou Z, Yan J, Gao J et al (2017). An economy-ralated equity analysis of health service utilization by women in economically underdeveloped regions of western China. Int J Equity Health, 16(1).
22. Memirie ST, Verguet S, Norheim OF, Levin C, Johansson KA (2016). Inequalities in utilization of maternal and child health services in Ethiopia: The role of primary health care Health systems and services in low and middle income settings. BMC Health Serv Res., 16(1):186.
23. Liu X, Wong H, Liu K (2016). Outcome-based health equity across different social health insurance schemes for the elderly in China. BMC Health Serv Res., 16: 9.
24. Wehby GL, Pawluk M, Nyarko KA, López-Camelo JS (2018). Explaining ethnic disparities in preterm birth in Argentina and Ecuador. Glob Public Health, 13(8):1126–43.
25. Saadi A, Himmelstein DU, Woolhandler S, Mejia NI (2017). Racial disparities in neurologic health care access and utilization in the United States. Neurology, 88(24):2268–75.
26. Whitfield GP, Carlson SA, Ussery EN et al (2018). Racial and ethnic differences in perceived safety barriers to walking, United States National Health Interview Survey – 2015. Prev Med (Baltim), 114:57–63.
27. Park YJ, Martin EG (2018). Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care. Health Serv Res., 53:2932–51.
28. Gao F, Kihal W, Meur N, Souris M, Deguen S (2017). Does the edge effect impact on the measure of spatial accessibility to healthcare providers? Int J Health Geogr., 16(1):46.
29. Brian D. Smedley, Stith AY, Nelson AR (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Available from: http://www.precaution.org/lib/iom_on_health_disparities.020601.pdf
30. Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W (2012). Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy Plan, 27(4):288-300.
31. Wang S, Kou C, Liu Y et al (2014). Rural–Urban Differences in the Prevalence of Chronic Disease in Northeast China. Asia-Pacific J Public Heal, 27(4):394-406.
32. Cheng L, Tan L, Zhang L et al (2013). Chronic disease mortality in rural and urban residents in Hubei Province, China, 2008-2010. BMC Public Health, 13:713.
33. Emamgholipour Sefiddashti S, Kazemi Karyani A, Ghazanfari S (2016). The disparity in geographical accessibility to healthcare resources in Iran: the comparison of two cross-section. Int J Hum Rights Healthc, 9(2):86–94.
34. Tourani S, Zarezadeh M, Raadabadi M, Pourshariati F (2017). Association of regional disparity of obstetrics and gynecologic services with children and infants mortality rates: A cross-sectional study. Int J Reprod Biomed (Yazd), 15(3):147–54.
35. Anjomshoa M, Mousavi SM (2014). Regional disparities in the distribution of health care facilities: Building evidence for evidence-based policy making. Iran J Public Health, 43(7):1020–1.
36. Rostami M, Karamouzian M, Khosravi A, Rezaeian S (2018). Gender and geographical inequalities in fatal drug overdose in Iran: A province-level study in 2006 and 2011. Spat Spatiotemporal Epidemiol, 25:19–24.
37. Mansori K, Solaymani-Dodaran M, Mosavi-Jarrahi A et al (2018). Spatial inequalities in the incidence of colorectal cancer and associated factors in the neighborhoods of Tehran, Iran: Bayesian spatial models. J Prev Med Public Health, 51(1):33–40.
38. Momenyan S, Kavousi A, Poorolajal J, Momenyan N (2018). Spatial inequalities and predictors of HIV/AIDS mortality risk in Hamadan, Iran: a retrospective cohort study. Epidemiol Health, 40: e2018038.
| Files | ||
| Issue | Vol 48 No 2 (2019) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i2.819 | |
| Keywords | ||
| Disparities Hospital utilization Urban-rural Indonesia | ||
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How to Cite
1.
LAKSONO AD, WULANDARI *Ratna D, SOEDIRHAM O. Urban and Rural Disparities in Hospital Utilization among Indonesian Adults. Iran J Public Health. 2019;48(2):247-255.
