Aile Hekimliğine Olan Talebi Etkileyen Faktörler: Davranışsal Model İçin Türkiye Verilerinden Kanıtlar

Yıl 2021, Cilt: 36 Sayı: 4, 949 - 959, 31.12.2021

Mehmet Nurullah Kurutkan , Hasan Hüseyin Yıldız , Tuba Arslan , Melek Terzi , Dilek Şahin

https://doi.org/10.24988/ije.889573

Cited By: 1

Öz

Bu çalışmanın amacı, kronik hastalıkların ve sosyo-ekonomik faktörlerin, aile hekimliğine yönelik talep üzerindeki etkilerini incelemektir. Kullanılan temel yaklaşım Andersen’in davranışsal sağlık modelidir. Değişkenler 2016 yılına ait “TÜİK Sağlık Araştırması” mikro veri setinden elde edilmiştir. Kronik hastalığa ait verilerin ve sosyo-ekonomik değişkenlerin sağlık talebini etkileme derecesini tespit etmek için üç model kurulmuştur. Modellerin analizinde Binary Logit Regresyon analizi kullanılmıştır. Değişkenlerden cinsiyet, yaş, çalışma durumu, öğrenme güçlüğü, konsantrasyon problemi, tedavi masraflarının Sosyal Güvenlik Kurumu (SGK) tarafından karşılanıyor olması, güvenilir yakınının bulunması, komşularından yardım alma, sağlık hizmeti randevularına gecikme yaşamaları, kronik hipertansiyon ve şeker hastalığına sahip olmaları aile hekimliğinden hizmet alma durumuna etki eden değişkenlerdir (p<0,05). Araştırma sonuçlarına göre, hipertansiyon, şeker ve zihin sağlığı parametreleri ile sosyo-ekonomik değişkenlerin, aile hekimliği hizmeti alma durumu üzerinde etkili olduğu belirlenmiştir. Politika yapıcılar, aile hekimliği sisteminin sürdürülebilir olması ve daha çok tercih edilmesi amacıyla, farklı kronik durumların, demografik ve ekonomik yapının karşılaştırmalı yüküne ilişkin ekonometrik modellere dayalı kanıtlardan faydalanabilir.

Anahtar Kelimeler

Aile Hekimliği, Davranışsal Model, Kronik Hastalıklar, Sağlık Talebi, Türkiye Sağlık Araştırması

Factors Affecting the Demand for Family Medicine: Evidence for Behavioral Model from Turkey Data

Öz

This study aims to investigate the effects of chronic diseases and socio-economic factors on the demand for family medicine. The basic approach used is Andersen's behavioral health model. The variables used in the analysis were obtained from the “TurkStat Health Survey” micro data set for 2016. Three models were established to determine the degree of chronic disease data and socio-economic variables affecting health demand. Binary Logit regression analysis was used in the analysis of models. The variables such as gender, age, employment status, learning difficulties, concentration problems, treatment costs covered by the Social Security Institution (SGK), having a reliable relative, receiving help from neighbors, delaying health care appointments, having chronic hypertension and diabetes are the variables that influence the condition of receiving service from the family medicine (p<0,05). According to the results of the research, it was determined that hypertension, diabetes, and mental health parameters and socio-economic variables are effective on the status of receiving family medicine services. Policymakers would benefit from evidence-based econometric models of the comparative burden of different chronic conditions, demographic and economic structures in order to ensure that the family medicine system is sustainable and more preferable.

Anahtar Kelimeler

Family Medicine, Behavioral Model, Health Demand, Turkey Health Interview Survey

Kaynakça

• Andersen, R. (1968). A behavioral model of families' use of health services. A behavioral model of families' use of health services., (25).
• Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior, 1-10.
• Atun, R. A., Kyratsis, I., Jelic, G., Rados-Malicbegovic, D., & Gurol-Urganci, I. (2007). Diffusion of complex health innovations—implementation of primary health care reforms in Bosnia and Herzegovina. Health policy and planning, 22(1), 28-39.
• Babitsch, B., Gohl, D., & Von Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9.
• Bradley, E. H., McGraw, S. A., Curry, L., Buckser, A., King, K. L., Kasl, S. V., & Andersen, R. (2002). Expanding the Andersen model: The role of psychosocial factors in long‐term care use. Health services research, 37(5), 1221-1242.
• Chong, W. F., & Ho, R. M. H. (2018). Caregiver needs and formal long-term care service utilization in the Andersen Model: An individual-participant systematic review and meta-analysis. International Journal of Integrated Care (IJIC), 18.
• Conner, N. E. (2012). Predictive factors of hospice use among blacks: applying Andersen's behavioral model. American Journal of Hospice and Palliative Medicine®, 29(5), 368-374.
• Dhingra, S. S., Zack, M., Strine, T., Pearson, W. S., & Balluz, L. (2010). Determining prevalence and correlates of psychiatric treatment with Andersen's behavioral model of health services use. Psychiatric Services, 61(5), 524-528.
• Fortin, M., Bamvita, J. M., & Fleury, M. J. (2018). Patient satisfaction with mental health services based on Andersen’s Behavioral Model. The Canadian Journal of Psychiatry, 63(2), 103-114.
• Fortin, M., Cao, Z., & Fleury, M. J. (2018). A typology of satisfaction with mental health services based on Andersen’s behavioral model. Social psychiatry and psychiatric epidemiology, 53(6), 587-595.
• Franck, J. E., Ringa, V., Coeuret-Pellicer, M., Chauvin, P., & Menvielle, G. (2020). The determinants of cervical cancer screening uptake in women with obesity: application of the Andersen’s behavioral model to the CONSTANCES survey. Cancer Causes & Control, 31(1), 51-62.
• Gökkaya, D. (2016). Bireylerin Hastalık Şiddeti Algısıyla Sağlık Hizmetleri Kullanımına Etki Eden Faktörlerin Değerlendirilmesi (Yüksek Lisans Tezi, Süleyman Demirel Üniversitesi, Isparta).
• Graham, A., Hasking, P., Brooker, J., Clarke, D., & Meadows, G. (2017). Mental health service use among those with depression: an exploration using Andersen's Behavioral Model of Health Service Use. Journal of affective disorders, 208, 170-176.
• Heider, D., Matschinger, H., Müller, H., Saum, K. U., Quinzler, R., Haefeli, W. E., ... & König, H. H. (2014). Health care costs in the elderly in Germany: an analysis applying Andersen’s behavioral model of health care utilization. BMC health services research, 14(1), 1-12.
• Hirshfield, S., Downing Jr, M. J., Horvath, K. J., Swartz, J. A., & Chiasson, M. A. (2018). Adapting Andersen’s behavioral model of health service use to examine risk factors for hypertension among US MSM. American journal of men's health, 12(4), 788-797.
• Holtzman, C. W., Shea, J. A., Glanz, K., Jacobs, L. M., Gross, R., Hines, J., ... & Yehia, B. R. (2015). Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's Behavioral Model. AIDS care, 27(7), 817-828.
• Hong, Y. R., Samuels, S. K., Huo, J. H., Lee, N., Mansoor, H., & Duncan, R. P. (2019). Patient-centered care factors and access to care: a path analysis using the Andersen behavior model. Public health, 171, 41-49.
• Imbus, J. R., Voils, C. I., & Funk, L. M. (2018). Bariatric surgery barriers: a review using Andersen’s Model of Health Services Use. Surgery for Obesity and Related Diseases, 14(3), 404-412.
• Jin, S. W., Yun Lee, H., & Lee, J. (2019). Analyzing factors enabling colorectal cancer screening adherence in Korean Americans using the Andersen's Behavioral Model of Health Services Utilization. Journal of psychosocial oncology, 37(6), 729-745.
• Kara, O., & Kurutkan, M. N. (2018). Mikro İktisadi Açıdan Sağlık Hizmetleri Piyasasının Analizi. Nobel Bilimsel Eserler, (113).
• Kaşko Y. (2007). Çoklu Bağlantı Durumunda İklili (Binary) Lojistik Regresyon Modelinde Gerçekleşen 1. Tip Hata ve Testin Gücü. (Yayımlanmamış Yüksek Lisans Tezi, Ankara Üniversitesi Fen Bilimleri Esntitüsü, Ankara)
• Kaya, S., Sain Guven, G., Aydan, S., & Toka, O. (2019). Predictors of hospital readmissions in internal medicine patients: Application of Andersen's Model. The International journal of health planning and management, 34(1), 370-383.
• Khedmati, J., Davari, M., Aarabi, M., Soleymani, F., & Kebriaeezadeh, A. (2019). Evaluation of urban and rural family physician program in Iran: a systematic review. Iranian journal of public health, 48(3), 400.
• Kılıç, D., & Çalışkan, Z. (2013). Sağlık hizmetleri kullanımı ve davranışsal model. Nevşehir Hacı Bektaş Veli Üniversitesi SBE Dergisi, 2(2), 192-206.
• Lee, Y. S., Roh, S., Moon, H., Lee, K. H., McKinley, C., & LaPlante, K. (2020). Andersen’s Behavioral Model to Identify Correlates of Breast Cancer Screening Behaviors among Indigenous Women. Journal of Evidence-Based Social Work, 17(1), 117-135.
• Liu, Z., Tan, Y., Liang, H., Gu, Y., Wang, X., Hao, Y., ... & Hao, C. (2019). Factors influencing residents’ willingness to contract with general practitioners in Guangzhou, China, during the GP policy trial phase: A cross-sectional study based on Andersen’s behavioral model of health services use. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 56, 0046958019845484.
• Ogunsanya, M. E., Jiang, S., Thach, A. V., Bamgbade, B. A., & Brown, C. M. (2016, December). Predictors of prostate cancer screening using Andersen’s Behavioral Model of Health Services Use. In Urologic Oncology: Seminars and Original Investigations (Vol. 34, No. 12, pp. 529-e9). Elsevier.
• Rivo, M. (1997). Family Practice In The New Millennium: From Health Care To Health Improvement. Fam Pract Manag. 33(4), 259-267.
• Roh, S., Burnette, C. E., Lee, K. H., Lee, Y. S., Martin, J. I., & Lawler, M. J. (2017). Predicting help-seeking attitudes toward mental health services among American Indian older adults: Is Andersen’s behavioral model a good fit?. Journal of Applied Gerontology, 36(1), 94-115.
• Strasser, R. (2003). Rural Health Around The World: Challenges And Solutions.
• Travers, J. L., Hirschman, K. B., & Naylor, M. D. (2020). Adapting Andersen’s expanded behavioral model of health services use to include older adults receiving long-term services and supports. BMC geriatrics, 20(1), 1-1.