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Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument
BACKGROUND: Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient h...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556801/ https://www.ncbi.nlm.nih.gov/pubmed/34717613 http://dx.doi.org/10.1186/s12913-021-07156-y |
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author | Yiengprugsawan, Vasoontara Sbirakos Dorj, Gantuya Dracakis, Jocelyn G Batkhorol, Bilegt Lkhagvaa, Undram Battsengel, Dulamsuren Ochir, Chimedsuren Naidoo, Nirmala Kowal, Paul Cumming, Robert G |
author_facet | Yiengprugsawan, Vasoontara Sbirakos Dorj, Gantuya Dracakis, Jocelyn G Batkhorol, Bilegt Lkhagvaa, Undram Battsengel, Dulamsuren Ochir, Chimedsuren Naidoo, Nirmala Kowal, Paul Cumming, Robert G |
author_sort | Yiengprugsawan, Vasoontara Sbirakos |
collection | PubMed |
description | BACKGROUND: Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. METHODS: Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). RESULTS: Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. CONCLUSIONS: This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-07156-y. |
format | Online Article Text |
id | pubmed-8556801 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-85568012021-11-01 Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument Yiengprugsawan, Vasoontara Sbirakos Dorj, Gantuya Dracakis, Jocelyn G Batkhorol, Bilegt Lkhagvaa, Undram Battsengel, Dulamsuren Ochir, Chimedsuren Naidoo, Nirmala Kowal, Paul Cumming, Robert G BMC Health Serv Res Research Article BACKGROUND: Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. METHODS: Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). RESULTS: Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. CONCLUSIONS: This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-07156-y. BioMed Central 2021-10-30 /pmc/articles/PMC8556801/ /pubmed/34717613 http://dx.doi.org/10.1186/s12913-021-07156-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Yiengprugsawan, Vasoontara Sbirakos Dorj, Gantuya Dracakis, Jocelyn G Batkhorol, Bilegt Lkhagvaa, Undram Battsengel, Dulamsuren Ochir, Chimedsuren Naidoo, Nirmala Kowal, Paul Cumming, Robert G Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title | Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title_full | Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title_fullStr | Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title_full_unstemmed | Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title_short | Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument |
title_sort | disparities in outpatient and inpatient utilization by rural-urban areas among older mongolians based on a modified who-sage instrument |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556801/ https://www.ncbi.nlm.nih.gov/pubmed/34717613 http://dx.doi.org/10.1186/s12913-021-07156-y |
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