The Rural-Urban Divide: Health Services Utilization Among Older Mexicans in Mexico

Abstract

Context-MexicoPurpose-Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods-TheMexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semirural). Findings-Resultsshowed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans.Conclusions-Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. Keywordshospitalization; insurance; Mexico; rural; urbanThe epidemiological transition has progressed through much of Mexico and, as a result, the population in Mexico is aging quickly.1 Mexico has now reached the juncture where health and quality of life in older age are a public health focus, yet little effort has been made to Health Care Access in MexicoIn Mexico, the health care system is work-based.9 Mexicans in the formal labor market access health care programs associated with the sector in which they are employed. Study FrameworkIn this study, we use Andersen's "Behavioral Model of Health Services Use" as a framework to demonstrate the disparity in health care utilization between rural and urban older Mexicans living in Mexico.22 Andersen initially developed the model in the late 1960s, grouping contributing factors into predisposing, enabling, and need as a way of illustrating patterns of health care utilization by families. Over the years, Andersen has revised the model to account for the growing complexities associated with medical care, shifting focus to the individual.Andersen's model has been used in a number of studies to characterize health care utilization in Hispanic populations.23 -25 Al Snih et al determined that need factors had the most predictive power in determining doctor visits and overnight hospitalization in older Mexican Americans, yet, in Mexico, Tamez-González et al found that enabling factors, particularly education, proved to be the most important in predicting prenatal...

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