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Int. J. Environ. Res. Public Health 2015, 12(2), 1745-1772; doi:10.3390/ijerph120201745

Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare

Department of Economics, Center for Children and Childhood Studies, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA
Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, 95 Grasslands Rd., Valhalla, NY 10595, USA
Department of Social Science, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 35 Gengo, Morioka cho, Obu-shi, Aichi-ken, 474-8511 Japan
Department of Civil Environmental Engineering, Iwate University, 4-3-5, Ueda, Morioka-shi, Iwate-ken, 020-8551 Japan
Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu-shi, Shizuoka-ken, 431-3192 Japan
Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba-shi, Chiba-ken, 260-8670 Japan
Department of Public Policy and Administration, Rutgers University, The State University of New Jersey, 311 North 5th Street, Camden, NJ 08102, USA
These authors contributed equally to this work.
Author to whom correspondence should be addressed.
Academic Editor: Ulf-G. Gerdtham
Received: 8 June 2014 / Revised: 29 October 2014 / Accepted: 21 January 2015 / Published: 3 February 2015
(This article belongs to the Special Issue Inequalities in Health)
View Full-Text   |   Download PDF [782 KB, uploaded 3 February 2015]   |  


The purpose of this study is to investigate healthcare access disparity that will cause delayed and unmet healthcare needs for the elderly, and to examine health inequality and healthcare cost burden for the elderly. To produce clear policy applications, this study adapts a modified PRECEDE-PROCEED model for framing theoretical and experimental approaches. Data were collected from a large collection of the Community Tracking Study Household Survey 2003–2004 of the USA. Reliability and construct validity are examined for internal consistency and estimation of disparity and inequality are analyzed by using probit/ols regressions. The results show that predisposing factors (e.g., attitude, beliefs, and perception by socio-demographic differences) are negatively associated with delayed healthcare. A 10% increase in enabling factors (e.g., availability of health insurance coverage, and usual sources of healthcare providers) are significantly associated with a 1% increase in healthcare financing factors. In addition, information through a socio-economic network and support system has a 5% impact on an access disparity. Income, health status, and health inequality are exogenously determined. Designing and implementing easy healthcare accessibility (healthcare system) and healthcare financing methods, and developing a socio-economic support network (including public health information) are essential in reducing delayed healthcare and health inequality. View Full-Text
Keywords: unmet healthcare needs; delayed healthcare; access and health disparity unmet healthcare needs; delayed healthcare; access and health disparity

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Yamada, T.; Chen, C.-C.; Murata, C.; Hirai, H.; Ojima, T.; Kondo, K.; III, J.R.H. Access Disparity and Health Inequality of the Elderly: Unmet Needs and Delayed Healthcare. Int. J. Environ. Res. Public Health 2015, 12, 1745-1772.

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